Psychiatric Home Visits

tabchloe · May 12, 2013

I have done psych home health for 2 yrs now and love it. I do medication mgmt, safety checks, education and a lot of therapeutic communication. The majority of the time I do feel safe but if I did not I would not enter a home without some form of backup, such as another nurse or a supervisor. It is very challenging but rewarding as you truly impact their lives and are often the only person they may come into contact with in the entire day. Unfortunately many times the home environments are less than ideal but this is often the result of the disease and/or economics and the difficulty in finding appropriate housing. If you want any more feedback or info feel free to let me know and I will help if I can!!!

msteeleart · May 17, 2013

I have been working 2 weeks as a psych community outreach nurse. I visit clients on Medicaid that have severe mental illnesses. I am only able to do pharmalogical management. I do a health and psych assessment. I find out what meds they are taking and how it is working for them. I also bring meds out to them from our pharmacy and do antipsychotic injections. I wish I could do more like teaching them coping skills but I found out today that case workers only do that. I haven't felt unsafe yet and sometimes I go to less than desirable neighborhoods but it is an 8 to 5 job so the sun is out and less bad stuff happens during the day.

QTNurseBSN · May 17, 2013

Thanks for your input I did home visits as a Public Health Nurse but I was not seeing patients with mental health diagnosis (not to my knowledge). There is a BIG push for Integrated Health Care in community based services. Providing patient education on their underlying diagnosis and how the medications can be effective while doing so in the comfort of the client's home can be a win-win for all. These clients, which have severe mental illnesses (SMI), requiring psych home health will also have underlying physical illnesses and possibly even substance abuse issues... so the combination of the three would require A LOT of patient education as well as the nurse making sure she understands the benefits and side effects of medications that may be taken for HTN and schizophrenia for example. And if this person has SA problems too... it could be very overwhelming. Not sure if this is something other psych nurses would even want to do or if working in a clinic is more suitable. Of course, if I ever felt unsafe I would not make the home visit, that simple. I think once you know your patients and if something just seems "not right" that you are not safe about venturing into alone, you just gotta go with your gut. I have always enjoyed patient education.. that's just something that as nurses we do ALL the time, even if you are not an "educator". Our patients rely on us to explain everything and give the rationale as to why it's important to be healthy and to follow the doctors orders.

ccoombs · May 22, 2013

I am an RN with an assertive community TX team. Much of my job is home visits. I do med management, lots of injections, assessments, individual and family education, and informal counseling. It's rare that I feel unsafe and even then it is usually due to environment and family or neighbors.

suzycap · May 22, 2013

I did home infusionHad armed guard for some visits. Not due to pts. Areas of drivebys and car jacking. Had reliable junker. Syringes big concern if word got out. I loved it. Laid off

suzycap · May 22, 2013

Thank you.

GalRN · Jun 18, 2013

I work as an ACT nurse and do a lot of home visits. At first I wasn't sure that I could do it safely. I have worked with the mentally ill in my area in multiple settings including in the correctional system, and I have seen many people, including some now receiving services through my team, be aggressive and threatening.

The difference- we know our clients. If someone is new to the team no one goes alone for a while. There are some people that I will never be alone with even in the clinic due to past behavior. For the most part I do feel safe though. When the team sees a client daily, they know when they are starting to decompensate. It would not be safe if we didn't know them as well as we do. I do a lot of injections on the fly but there are some people who I have never seen in the clinic who don't need shots. It frees up the case managers when they are short staffed because it eliminates a round trip drive that they would have if they brought the person to me.

Seeing someone where they are comfortable is a really good way to get a more accurate assessment.

It is a huge benefit to me personally that I can switch my schedule and be out of the clinic when I can't sit still behind my desk anymore. I don't know how anyone gets any work done there with all of the hubbub.

I also go to the medical doctor with them sometimes, visit them in the hospital, and on occasion sit with them in the ER to make sure they are cared for as if they did not have a mental illness.

QTNurseBSN · Jun 19, 2013

The community agency I work for offered me a position that is part telemedicine for our clients that do not have a primary care physician and part home visits for med management and education. These clients will be referred from within the agency and will have dual diagnosis to include history of substance abuse. The primary medical focus for now will be hypertension, diabetes and respiratory issues. The telemedicine aspect is very interesting because the physician will be in another part of the state. We will utilize a secure polycom and have special equipment to include a stethoscope which will allow the doc to hear, via headphones, the clients heart and lung sounds. Plus equipment to visualize the clients eyes, ears, nose, throat and skin close up. I'm pretty excited to be a part of this. Home visits will be similar to our ACT team but different. I've been advised that home environments are not always the best, infestations are common (roaches, bed bugs) and to always wear scrubs! I may even opt to change clothes before going home when visiting the infested homes.

Are others doing telemedicine in their outpatient psychiatric clinics? How do you prevent bringing "bugs" home from clients homes. All advice and/or suggestions are welcome.