HOME TEACHING – Objectives of Health Education, Topics for Teaching at Home Setting, Principles of Health Education, Conducting Delivery at Home, Preparation of the Mother for Home Delivery, Maternity Kit, First Stage of Labor (in the Home), Second Stage, Third Stage, Immediate Care of the Newborn and Instruction to Family (COMMUNITY HEALTH NURSING)
- Health teaching or education is a holistic process with intellectual psychological and social dimension related to activities that increase the abilities of people to make informed decisions that affect their personal, family and community well being
- Health education is a process that informs, motivates and helps people to adopt and maintain healthy practices and lifestyles, advocates environmental changes needed to facilitate this goal and conducts professional training and research to the same end
OBJECTIVES OF HEALTH EDUCATION
The WHO has stated the aims of health education as follows.
- To ensure that health is valued as an asset to the community
- To equip the people with skills, knowledge, and attitudes to enable them solve their health problems by their own actions and efforts
- To promote the development and proper use of health services
- Other members of the family may be involved, who can have greater influence and control on the individual
- It gives chance for the nurse to look for new health problems
TOPICS FOR TEACHING AT HOME SETTING
- Antenatal mother: the nurse can teach normal anatomy and physiology of reproductive system and process of conception. The nurse provides teaching about the importance of antenatal checkup, diet, avoidance of drugs, importance of exercises, recognition of danger, signals during pregnancy and preparation of safe delivery
- Postnatal mother: the community health nurse should teach about postnatal hygiene, diet, exercises, breast care, breastfeeding, family planning and newborn care. The nurse should provide information about long-term postnatal teaching regarding newborn care, dangers of native medicine, immunization, prevention of infection and breastfeeding
- New natal care: the nurse should teach to the mother and family about newborn care, breastfeeding, prevention of infection about long-term plan such as prevention of diarrhea, acute respiratory tract infections, child safety, worm infestation, additional foods, etc
- Infant: the nurse should provide knowledge through teaching cum demonstration to the family and the mother about the infant’s immunization, prevention of diarrhea, malnutrition, child safety and additional foods
- Preschool children: the nurse should teach in the home set up to the mother and family members about pre-school diet, safety, monitoring growth and development, preschool education, prevention of diarrhea, scabies, worm infestations and acute respiratory tract infections
PRINCIPLES OF HEALTH EDUCATION
- Health teachings help the people to develop interest in improving their own living conditions. It happen when health teachings are based on felt needs of the family
- Health teaching should be based on the principle of interest
- The nurse should adopt the methods for health education should encourage people’s participation
- The health teaching program should focus from known to unknown
- The nurse should consider the factors such as level of understanding, education and literacy of people to whom the teaching is directed
- The nurse should maintain good human relationship with the educational approaches
- Provide opportunities for the people to learn by doing
- Help the people to motivate to have desire change in their attitudes and behaviors
- Reinforce the message by repeating and using different methods and medias
CONDUCTING DELIVERY AT HOME
- Delivery stage or labor is also known as intranatal period. Full form normal delivery occurs after nine months or 40 weeks. The normal delivery period is about 24 hours. This time period is very critical for the health and survival of both mother and child
- Domiciliary or home deliveries are conducted only normal and low risk mothers by trained dais, auxillay nurse midwives, lady health visitors, etc
PREPARATION OF THE MOTHER FOR HOME DELIVERY
- The main aim of preparation for natural child birth is to teach the ability to relax mentally and physically during the first stage
- To teach the intelligent use of the body muscles during the second stage and so to produce a natural, controlled, interesting and happy confinement
- To teach exercises for the muscles or the pelvic floor and joint mobility and improvement of posture
MATERNITY KIT
- Plastic bag, containing plastic apron and sheet, with soaps, nailbrush and towel in a waterproof bag – 1
- Kidney tray – 2
- Bowls (lotion) – 2
- Artery forceps – 2
- Dissecting forceps – 2
- Scissors – 1
- Bowl lifting forceps – 1 pair
- Gloves – 1 pair
- Instrument box (containing syringe and needles) – 1
- Complete set of enema can with connection – 1 (tubing catheter and clamp)
- Uretheral catheter (rubber) – 1
- Mucus extractor – 1
- Spring balance – 1
- Oral thermometer – 1
- Rectal thermometer – 1
- Stock of cotton for making boiled swabs – 1
- Sterile gauze pieces for cord dressing, mouth wipes cord binders
- Dettol -1 bottle
- Spirit – 1 bottle
- Bottle with antiseptic drops for baby’s eye – 1
- Bottle with cord – 1
- Fetoscope – 1
- Measuring tape – 1
OTHER ARTICLES NEEDED
- Newspaper, clean banana leaves or jute sacks
- Chula (stove)
- Large container to be used as sterilizer
- Shallow mud pots about 8” diameter (town mothers may provide bed pan)
- Linen – properly prepared and adequate in quantity
- For mother – sanitary towels or old rags that have been washed, boiled and ironed
- Bed covering
- Specially scrubbed bed, floor canvas or clean mat
- Drinking vessel
ARTICLES NEEDED FOR BABY
- Enough clothes – washed, dried clean clothes used to wrap the baby
- Katori (cup) for oil, if used
- Soap
- Cotton wool or small pieces of clean soft old rag
- Cradle with firm bottom
- Katori (cup) and spoon for boiled drinking water
- Bottle with cork for boiled water
FIRST STAGE OF LABOR (IN THE HOME)
- Greet the family and ascertain details regarding duration of labor pain, etc
- Reassure mother and family and place midwifery bag on newspaper
- Place your watch and other personal belonging in a convenient safe place
- Ask the family to prepare boiling water
- Take out soap and towel from midwifery bag
- Wash hands thoroughly under running water and dry
- Put on the apron, prepare the mother for examination
- Examine the mother palpate abdomen and ascertain positions, watch nature of pain, enquire about bowel action, when urine is passed, etc. if mother is in first stage give enema, examine the urine and take blood pressure
- Wash hands and take out the necessary equipment from bag and put them in a covered container and boil for 20 minutes (enamel bowls, 2 kidney trays, 2 covered basins, a pair of artery forceps, scissors, 1 teaspoon, cord tie)
- Boil eye dropper and syringe and cotton swab (if required) separately
- Boil gloves and catheter (if used) separately and check temperature
- Watch the progress of labor and give sufficient nourishment (tea, milk, etc)
- Prepare to receive baby
SECOND STAGE
- Wash hands and put on mask
- Set up articles for confinement on newspaper or clean banana leaf in order to use
- Prepare about a pint of lotion 2% (3 drachma in a pint)
- Take a sterile bowl, artery forceps, sterile swab and prepare for perineal wash
- Place the mother in a comfortable position for delivery and bring mother down towards foot end of bed leaving enough space for delivering baby
- Scrub hands thoroughly for about three minutes using germicides
- Swab the perineum with dettol lotion, swab away from vaginal orifice
- Support perineum with the sterile pad and deliver the baby as it has been taught
- Soon after the baby’s head is delivered, clean the eyes, nose and mouth to remove mucus and if necessary suck out mucus by a mucus catheter
- Separate the cord and baby, soon the pulsation of the cord stops
THIRD STAGE
- Keep a kidney tray or mud pot ready to receive placenta
- Wash hands thoroughly with soap
- Watch for the separation of placenta and deliver it as you were taught
- Rinse hands and lean the perineum, examine the labia and perineum for lacerations or tears
- Apply sterile pad loosely and make the mother comfortable
- Examine the placenta to see that all parts are complete.
- Wash hands thoroughly
- Take the mother’s temperature, pulse and respiration
- Assemble all the articles, wash them and if possible boil and replace in the midwifery bag
- Examine the mother carefully before leaving the home
IMMEDIATE CARE OF THE NEWBORN
- Prepare equipment for baby’s bath in a protected corner of the room, baby clothing, methylated spirit and spring balance
- Wash hands, put on apron, take the baby in lap after protecting lap with a sheet
- Remove the excess vernix on the skin and do not bath unless the family insists
- Put one drop of 1% silver nitrate in each eye
- Inspect the cord for seepage and if bleeding, religature and apply tincture of benzoin iodine, dress and cord if required or if indicated
- Inspect the infant thoroughly for abnormalities
- Put the child in clean clothes
- Place the baby in the bed with head on one side
- Remove apron, clean and replace equipment
INSTRUCTION TO FAMILY
- Watch for abnormal bleeding of mother and report if unusual amount appears. Watch for any bleeding from the cord, if it bleeds, take the child to the doctor
- Place the baby to the breast after 6 to 12 hours
- Teach to do proper perineal care as per using soap and water and change of sanitary pads as indicated
- Advice the family to give full diet. She needs food to regain her strength and help ensure sufficient milk for the baby
