Competencies of Home Visiting in Oregon

1. Home Visiting Core Competencies

2. Public Health Nurse Competencies 

3. Nursing Diagnosis and Care Planning

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The National Family Support Competency Framework divides the core competencies for home visitors into ten domains. Each domain is further divided into dimensions and components (which are the skills of each dimension). Components are further broken down into levels of growth (recognize, apply, extend). 

The ten core competency domains are:

1. Infant and Early Childhood Development
2. Child Health, Safety and Nutrition
3. Parent-Child Interactions
4. Dynamics of Family Relationships
5. Family Health, Safety and Nutrition
6. Community Resources and Support
   
7. Relationship-based Family Partnerships
   
8. Culturally and Linguistic Responsivness
   
9. Effective Home Visits
   
10. Professional Practice
    

The Quad Council Coalition of Public Health Nursing Organizations developed the Public Health Nurse Competencies in 2018. The document describes three core functions of Public Health, which are Assessment, Policy Development, and Assurance. Within these core functions are 10 essential services (e.g., monitor health status to identify and solve community problems; inform, educate, and empower people about health issues; and link people to needed personal health services). Home visiting services encompass many of the ten essential public health nurse activities. In nurse home visiting, public health core functions and activities are carried out within the framework of the nursing process. 

Nursing Diagnosis and Care Planning 

The nursing process in home visiting

1. Assess the client's strengths, risks and needs,
2. Identify a nursing diagnosis,
3. Create a care plan using evidence-based and evidence-informed tools and practices,
4. Implement the nursing plan of care, and

5. Evaluate outcomes.
   

The five steps of the nursing process flow into a continuous loop of activities, beginning with the nursing assessment of the client's strengths and needs. Then, based on the assessment, the nursing diagnosis (or problem statement) is chosen. The diagnosis and assessment inform care planning and the choice of interventions. After interventions are begun, and there has been time for action, progress toward goals is evaluated. From there, further assessment may be needed and adjustments to diagnosis, planning, and interventions may be made. Periodic evaluation and adjustment provide tailored support as the client reaches for their goals. Nurse home visiting interventions encompass public health interventions, and this is illustrated below (Figure 1).

Figure 1. Minnesota Department of Health. (2019). Public health interventions: Applications for public health nursing practice (2nd ed.).