Community-Based Nursing Practice

Community-Based Nursing Focused on individual and family health needs Moving from traditional settings to community/neighborhood locations Integrated system of health care including institutions, providers, agencies, policies, payment plans, families and of course patients

Community-Based Nursing Provides health services where people spend their time Traditionally such as: home (home care nursing), work (occupational nursing), school (school nurse)

Community-Based Services Evolved to include various settings Senior centers Day care centers Storefront clinics Homeless shelters Mental health centers Drug rehab programs Ambulatory care centers Outreach centers Institution-based centers Parish nursing Hospitals

Vulnerable Populations Immigrants Poor/Homeless persons Abused clients Substance abusers Severely mentally ill persons Older adults

Developmental Assessment Four steps: 1. Determine family’s developmental stage 2. Consider family member’s health problems in context of tasks of their developmental stage 3. Determine if family members are meeting the tasks at their individual levels of development 4. Identify nursing interventions that would facilitate family meeting their developmental tasks

Limitations of the Developmental Assessment Approach Changing demographics, variations in family structures (not all families fit neatly into stages) Nurse’s viewpoint has to take structure into account, thus, assessment becomes more complicated Family conflicts cause difficulty, compounded by individuals’ role disruption from illness

Structural Family Assessment Considers composition of family Can be very helpful to nurse in many situations May be a good assessment to start with

Functional Family Assessment Six family functions: 1.Affective 2.Healthcare and physical necessities 3.Economics 4.Reproduction 5.Socialization and placement 6.Family coping

Nursing Process The purpose of writing a family nursing diagnosis is to help the family promote health through the life cycle and prevent disease through low-risk-taking behaviors In planning phase, delineate expected outcomes for family health; Use mutual goal-setting with family  Process of collaborative goal-setting should have positive influence on nurse’s interactions with families  Also facilitates adherence to agreed-upon plan of care  Remember: Assessment is a two-way enterprise; the family is assessing you, as well

Examples of Family Nursing Diagnosis Theoretical Model Model Stage Stage Health Health Status Status Pattern Pattern Problem Problem Developmental Family with Preschoolers Potential for physical injury Health-Perception-HealthManagement Medications & poisonous cleaning substances within reach of children Family with adolescentsPotential alteration in parentingRoles-relationshipspattern Value systems of Parents & adolescent members in conflict Risk Factors Young couple Compromised & ineffectiveCoping-stress- tolerance pattern Teenage marriage Pregnancy before age 16 From: C. Edelman & C. Mandle (2002) Health promotion throughout the lifespan. St. Louis: Mosby.

Steps in the Planning Process 1. Prioritize problems & potential problems 2. Determine which items can be handled by the nurse and the family, and items that must be referred to others 3. Decide on actions and expected outcomes

Goals Goals describe a desired outcome Goal statements include: –The expected behaviors of the family –The circumstances under which the behaviors will be demonstrated –Criteria by which to determine when and how the behaviors will be performed Health promotion goals reflect a desire to function at a higher level of health and to grow beyond maintaining health or preventing disease Health promotion goals reflect a desire to function at a higher level of health and to grow beyond maintaining health or preventing disease

Implementation With The Family Family nursing interventions aim to assist family members in carrying out functions that the members cannot perform for themselves –Health promotion: the nurse assists the family in improving their capacity to act on its own behalf Three Broad Categories of Interventions with Families –Cognitive interventions –Affective interventions –Behavioral interventions

Four Types of Interventions are Found in Health Promotion/Disease Prevention Increasing knowledge and skills Increasing strengths Decreasing Exposure Decreasing susceptibility

Evaluation With The Family Purpose of evaluation is to determine how the family has responded to the planned interventions. Concrete objectives are easier to measure Family’s baseline data needs to be used as comparative criteria in evaluation Five measures of family functioning that can be used to determine effectiveness of interventions 1.Changes in interaction patterns 2.Effective communication 3.Ability to express emotion 4.Responsiveness to needs of members as individuals 5.Problem-solving ability If goals are not met, review process

Health Promotion/Prevention Strategies as Applied to the Family Primary Prevention Completing a family genogram and assessing health risks with the family to contract for family health activities to prevent diseases from developing Completing a family genogram and assessing health risks with the family to contract for family health activities to prevent diseases from developing Secondary Prevention Using a behavioral health risk survey and identifying the factors leading to obesity in the family Using a behavioral health risk survey and identifying the factors leading to obesity in the family Tertiary Prevention Developing a contract with the family to change nutritional patterns to reduce further complications from obesity Developing a contract with the family to change nutritional patterns to reduce further complications from obesity

Three Levels of Prevention

Adults age 65 and over who ever received pneumococcal vaccination, Source: Centers for Disease Control and Prevention, National Center for Health Statistics, National Health Interview Survey,

Components of a Community Assessment Community: an entity made up of people, a place, and social systems The characteristics of a “healthy community” can be used to assess a community’s health Community assessment is a problem-solving process similar to the nursing process

Community Assessment Community-based vs community-oriented nursing All three dimensions of community are assessed: –The people –The place –The social systems Community assessments vary in scope and complexity; nurse’s role depends on nurse’s educational preparation and expertise

People Demographic characteristics: number, composition by age, rate of growth and decline, social class and mobility of people in the community Other vital statistics: birth rate, overall death rate, death rate by cause and age, and infant mortality rate Infant mortality rate is considered to be the most important statistical indicator of maternal- infant health in the communityInfant mortality rate is considered to be the most important statistical indicator of maternal- infant health in the community

Place Where the community is located and its boundaries Type of community (e.g., rural or urban) Location of health services Climate: flora, fauna & topography

Social Systems Economic Educational Religious Political Legal Human services Recreation Communication systems

Epidemiology: “The study of the distribution and determinants of health- related states or events in specified populations, and the application of this study to control of health problems”

Descriptive Epidemiology: Study of the distribution of disease and other health- related states in terms of: –personal characteristics (person) –geographical distribution (place) –temporal patterns (time)

Analytic epidemiology: Studies the origins and causal factors of disease and other health-related states and events

The Epidemiologic Triangle Represents complex relationships among: –causal agents –susceptible persons –environmental factors

Stages of Health and Prevention Susceptibility Primary prevention prevention Asymptomatic Secondary disease prevention disease prevention Clinical Tertiary manifestations prevention manifestations prevention