Community Mental Health Nursing (RCMN)
HOME VISIT TO A CLIENT WITH POSTPARTUM DEPRESSION/PEUPERAL PSYCHOSIS
This is a purposeful visit by the RCPN to the home of a client suffering from postpartum depression. The nurse renders care to the client, baby, husband and the family with respect to their specific health needs.
Purpose
- Meet the specific health needs of the client, baby, husband/partner and family in their home environment
- Monitor the progress of treatment, recovery and the coping strategies of the client
- Assess client's home environment for safety to prevent suicide and or infanticide
- Prevent recurrence
- Assess and identify stressors in the environment
- Maintain continuity of care
- Maximise client, family and societal level of independence of health or wellbeing
- Ensure compliance
- Build confidence of the client and family
Indications
- Home visits to a client suffering from postpartum depression or puerperal psychosis.
- Assessing the home environment for safety to prevent suicide or infanticide.
- Supporting the client, baby, husband or partner and family during recovery.
Equipment
- A Well-Equipped Home Visit Bag
- Community Map and or GhanaPost Global Positions System (GPS)
- Manual/electronic area register/ records of the client
- Means of Transportation
Preparation
- Read the community map or GPS and identify the home of the client.
- Carry a well-equipped home visit bag and arrange transportation.
Procedure steps
- Read map of the community to identify the home of the client
- Announce your presence, enter on response, greet and introduce yourself to client, family and significant others
- Explain the purpose of the visit to client, husband/partner and family
- Establish rapport (refer to procedure) and enquire about the general health of client and baby
- Approach client in a calm and respectful manner to gain her trust
- Ensure privacy and confidentiality by asking client and family to identify a suitable place for the interaction
- Involve caregiver in the interaction with the consent of client
- Educate and Counsel client, husband/partner and family on:
- Health of client and baby
- Occupation and or schooling
- Disease condition
- Possible recurrence after each delivery
- Personal and environmental hygiene needs and safety
- Nutritional status of client and baby
- Sleep pattern
- Underlying medical conditions/infections
- Assess client's level of depression and other psychotic symptoms
- Enquire from family and husband any history of alcohol and or substance use
- Enquire from husband/partner and family about client's activities of daily living
- Enquire from husband/partner and family about contact hours of client with her baby
- Encourage the family members to identify a surrogate for the baby if necessary
- Educate surrogate on the care of the baby
- Refer mother and baby to the social welfare department for assistance if necessary
- Encourage husband/partner and family to show love and affection
- Advise husband/partner to provide physical and financial support
- Educate family members on suicidal cues
- Refer client and husband/partner to a family planning clinic
- Educate client, husband/partner and family on the condition with emphasis on:
- Signs and symptoms of relapse
- Adherence to treatment regimen
- Effective communication
- Good interpersonal relationship
- Refer client, husband/partner and family for psychotherapy
- Counsel husband/partner and family members not to leave baby alone with client
- Educate husband/partner and family on client's self harm and possible infanticide
- Refer problems beyond scope to the nearest unit or health facility
- Inform client/family about your next visit
- Leave your contact with client/caregiver and encourage them to call in case of emergency
- Document the care and findings in the report book
- Express appreciation and depart
Precautions
- Assess the client's level of depression and other psychotic symptoms.
- Counsel the husband or partner and family not to leave the baby alone with the client.
- Educate family members on suicidal cues and the risk of self-harm and possible infanticide.
- Refer the client, husband or partner and family for psychotherapy and refer problems beyond scope to the nearest unit.
Aftercare
- Refer the mother and baby to the social welfare department for assistance if necessary.
- Refer the client and husband or partner to a family planning clinic.
- Inform the client and family about the next visit and leave emergency contact details.
Nursing considerations
- Enquire about the client's activities of daily living and contact hours with the baby.
- Encourage the husband or partner and family to show love and affection and to provide physical and financial support.
- Identify a surrogate for the baby if necessary and educate the surrogate on the care of the baby.
Patient education
- Educate the client, husband or partner and family on the condition, emphasising signs of relapse, adherence to treatment and effective communication.
- Counsel the husband or partner and family not to leave the baby alone with the client.
- Educate family members on suicidal cues and the risk of self-harm and possible infanticide.
Documentation
- Document the care and findings in the report book.
References and further reading
Educational resource only. Follow current Nursing and Midwifery Council guidance, local institutional protocols, scope of practice, and clinical supervision.
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