Community – based nursing

Key terms: Community – People and the relationships that emerge among them as they develop and use in common some agencies and institutions and share a physical environment. Community – based – occurs outside an institution; services are provided to individuals and families in a community. Community – based nursing – the provision of acute care and care for chronic health problems to individuals and families in the community.

Growing costs of hospital care More services are being provided in community – based settings Increasingly, nurses will engage in what is called community – based nursing (CBN)

The main focus and aim of CBN In CBN the nurse focuses on “illness care” of individuals and families across the life span. The aim is to manage acute and chronic health condition in the community, and the practice is family – centered illness care. CBN is not a specialty in nursing but rather a philosophy that guides care in all nursing specialties.

The main characteristic features of CBN Philosophy. Focus is on “illness care” of individuals and families across the life span. Goal. Manage acute or chronic conditions. Service context. Family – centered illness care. Community type. Human ecological.

The main characteristic features of CBN Client characteristics.  Individuals  Families  Usually ill  Culturally diverse  Autonomous  Able to define own problem  Involved in decision making

The main characteristic features of CBN Practice settings.  Community agencies  Home  Work  School Interaction patterns. One – to- one Type of service. Direct illness care

The main characteristic features of CBN Emphasis on levels of prevention.  Secondary  Tertiary  May be primary

The main characteristic features of CBN Roles. Client and delivery oriented.  Caregiver  Educator  Counselor  Advocate  Case manager Group oriented.  Leader (disease management)  Change agent (managed – care services)

The main characteristic features of CBN Priority of nurse activities.  Care management (direct care)  Patient education  Individual and family advocacy  Interdisciplinary practice  Continuity of care provider

Four key nursing modes in the community 1. Community-Oriented Nursing Practice: a philosophy of nursing care delivery that involves generalist or specialist public health and community health nurses providing "health care" through community diagnosis in order to create conditions in which people can be healthy.

Four key nursing modes in the community 2. Public Health Nursing Practice: the synthesis of nursing and public health theory applied to promoting and preserving the health of populations. The goal is to prevent disease and disability and promote and protect the health of the community as a whole.

Four key nursing modes in the community 3. Community Health Nursing Practice: the synthesis of nursing and public health theory to promote, preserve, and maintain the health of the population through the delivery of personal health services to individuals, families, and groups. Focus is on the health of individuals, families, and groups and how their health status affects the community as a whole.

Four key nursing modes in the community 4. Community-Based Nursing Practice: a setting-specific practice whereby care is provided for "sick" individuals and families where they live, work, and attend school.

Challenges for the future At present, the trend is to move more care into community settings and to reduce the number of hospital days for "sick" clients Reasons: community care is often much less expensive than hospital care care in the community is usually more appealing to people who prefer to remain at home rather than be treated in a hospital

The role of the nurse in community settings will likewise grow and continue to change

Community – based ethical theory Ethics is a body of knowledge and, as such, is more than "being a good person." Ethics is a part of clinical decision making and practice