1. Observe family for coping behavior patterns. Obtain family and client history as able.
Obtaining a family assessment provides a wealth of information regarding current family functions and can guide interventions (Leske, 1998).
2. Assess for suicidal tendencies. Refer for mental health care immediately if indicated. Identify an emergency plan should the client become suicidal.
A suicidal client is not safe in the home environment unless supported by professional help.
3. Refer to medical social services for evaluation and counseling, which will promote adequate coping as part of the medical plan of care. If no primary medical diagnosis has been made, request medical social services to assist with community support contacts.
4. If the client is involved with the mental health system, actively participate in mental health team planning.
Based on knowledge of the home and family, home care nurses can often advocate for clients. These nurses are often requested to monitor medications and therefore need to know the plan of care.
5. Refer patient/family to support groups.
Support groups foster the sharing of common experiences and help to build mutual support. They are particularly helpful when others within the family are unable to provide support because of their own grieving or coping needs (Leske, 1998).
6. If monitoring medications, contract with client or solicit assistance from a responsible caregiver. Pre-pouring of medications may be helpful with some clients.
Successful contracting provides the client with control of care and promotes self- esteem while establishing responsibility for desired actions.
NOTE: All of the previously mentioned interventions may be applied in the home setting. Home care may offer psychiatric nursing or the services of a licensed clinical social worker under special programs. Traditionally, insurance does not reimburse for counseling that is not related to a medical plan of care unless it falls under one of the programs just described. Public health agencies generally do not have the clinical support needed to offer psychiatric nursing services to clients. Clients are usually treated in the ambulatory mental health system.