1. Nurse Settings for Community Health Nursing.

2. Lecture objectives: Upon finishing this lecture, you should be able to: Describe seven settings in which community health nurses practice. Discuss the nature of community health nursing, and the common threads basic to its practice, woven throughout all roles and settings. Identify principles of sound nursing practice in the community.

3. Community Health Nurse Practice Is focussed on wellness not sickness. Is focussed on prevention not just treatment of problems. Is focussed on assisting people and communities make their own decisions regarding health care. Is focussed on assisting those with existing health conditions to maximise their potential and prevent deterioration if possible.

4. Community Health Nurse Practice Is based in the community in a range of settings, wherever there is a need for support, information and education. Responds to public health needs in relation to communicable diseases.

5. Community Health Nurse Practice Has the whole community as their client, as well as groups, families and individuals. Recognises the impact of life course and social determinants of health and works in partnership with the community to address these.

6. Community Health Nurse Practice Utilises the primary health care philosophy to guide practice. Has a specialised body of knowledge which reflects current research and evidence based practice.

7. Community Health Nurse Practice Community health nurses recognise health as “ a state of complete physical, mental and social well-being and not merely the absence of disease and infirmity” W.H.O. Community health nurses deal with clients in a holistic manner, working with them wherever they are on the health – illness continuum.

9. What is different about practice of community health nurse Community health nurse practice, by the nature of the work setting, requires autonomy, self-direction and use of a high level of professional judgement.

11. Work settings for community health nurses The types of places in which community health nurses practice are increasingly varied and include a growing number of nontraditional settings and partnerships with nonhealth groups. Employers of community health nurses range from state and local health departments and home health agencies to managed care organizations, industries, and nonprofit organizations.

12. Work settings for community health nurses These settings are grouped into seven categories: (1) homes, (2) ambulatory service settings, (3) schools, (4) occupational health settings, (5) residential institutions, (6) parishes, (7) the community at large.

13. What is different about practice of community health nurse Community health nurses interact with a wide range of both professional and non professional people within the community and must have a variety of interpersonal skills.

15. Homes For a long time, the most frequently used setting for community health nursing practice was the home. In the home, all of the community health nursing roles are performed: – Clients who are discharged from acute care institutions, such as hospitals or mental health facilities, are regularly referred to community health nurses for continued care and follow-up. – Here, the community health nurse can see clients in a family and environmental context. – Service can be tailored to the clients’ unique needs.

16. Homes: Health promotion Many community health nursing visits focus on assisting families to understand and practice healthier living behaviors: – Nurses may, for example, instruct clients on parenting, infant care, child discipline, – diet, exercise, – coping with stress, – or managing grief and loss.

17. Homes: The diversity The character of the home setting is as varied as the clients served by the community health nurse. In one day, the nurse may visit – a well-to-do widow in her luxurious home, – a middle-income family in their modest bungalow, – an elderly transient man in his one-room fifth-story walk-up apartment, – and a teen mother and her infant living in a group foster home. In each situation, the nurse can view the clients in perspective and, therefore, better understand their limitations, capitalize on their resources, and tailor health services to meet their needs.

18. Home visits anxiety for the nurse. – nurse’s first experience outside the acute care, long- term care, or clinic setting. – visiting families in unfamiliar neighborhoods. – fear of the unknown. – collaboration with various types of home care providers, including hospitals, other nurses, physicians, rehabilitation therapists, and durable medical equipment companies

19. Ambulatory service settings include a variety of venues for community health nursing practice in which clients come for day or evening services that do not include overnight stays. – Community health centers – Multiple clinics offering comprehensive services – Family planning clinics or a well-child clinics – Day care centers, such as those for physically disabled or emotionally disturbed adults – Offices (for example, a community health nurse associated with a health maintenance organization sees clients in the office and undertakes screening, referrals, counseling, health education, and group work.

20. Ambulatory service settings cont – Independent nursing agencies that practice by seeing clients in community nursing centers as well as making home visits. Another type of ambulatory service setting includes places where services are offered to selected groups. – community health nurses practice in migrant camps, – through churches as parish nurses, – in remote mountain and coal-mining communities.

21. Schools Schools of all levels make up a major group of settings for community health nursing practice. Nurses from community health nursing agencies frequently serve private schools at elementary and intermediate levels. Public schools are served by the same agencies or by community health nurses hired through the public school system. The community health nurse may work with groups of students in preschool settings as well as in vocational or technical schools, junior colleges, and college and university settings. Specialized schools, such as those for the developmentally disabled, are another setting for community health nursing practice.

22. Occupational Health Settings Business and industry provide another group of settings for community health nursing practice. Community health nurses in occupational health settings practice a variety of roles: clinician role – The clinician role was primary for many years, as nurses continued to care for sick or injured employees at work. health education – However, recognition of the need to protect employees’ safety and, later, to prevent their illness led to the inclusion of health education in the occupational health nurse role. employee advocates – Occupational health nurses also act as employee advocates, assuring appropriate job assignments for workers and adequate treatment for job-related illness or injury.

23. Residential Institutions Any facility where clients reside can be a setting in which community health nursing is practiced. Residential institutions can include – a halfway house in which clients live temporarily while recovering from drug addiction, – an inpatient hospice program in which terminally ill clients live. Some residential settings, such as hospitals, exist solely to provide health care; others provide other services and support.

24. Residential Institutions cont A continuing care centers: – In this setting, residents usually are elderly; some live quite independently, whereas others become increasingly more dependent and have many chronic health problems. The community health nurse functions as advocate and collaborator to improve services.

25. Residential Institutions cont Residential institutions provide unique settings for the community health nurse to practice health promotion. Clients are a “captive” audience whose needs can be readily assessed and whose interests can be stimulated. These settings offer the opportunity to generate an environment of caring and optimal-quality health care provided by community health nursing services.

26. Parishes Parish nursing finds its beginnings in an ancient tradition. In parish nursing today, the practice focal point remains the faith community and the religious belief system provided by the philosophical framework Parish nursing may take different names, such as: – church-based health promotion (CBHP), – faith community nursing, or – primary care parish nursing practice (PCPNP).

27. Parish nursing Involves a large-scale effort by the church community to improve the health of its members through education, screening, referral, treatment, and group support.

29. Community at Large Unlike the six settings already discussed, the seventh setting for community health nursing practice is not confined to a specific philosophy, location, or building. When working with groups, populations, or the total community, the nurse may practice in many different places.

30. Community at Large For example, A community health nurse, as clinician and health educator, may work with a parenting group in a church or town hall. Another nurse, as client advocate, leader, and researcher, may study the health needs of a neighborhood’s elderly population by collecting data throughout the area and meeting with resource people in many places. A nurse may work with community-based organizations such as an AIDS organization or a support group for parents experiencing the violent death of a child.

31. Tasks for practical 1. Search the Internet or go to the library and find two sources of health-related information for consumers. Was the information accurate? 2. Search the Internet or go to the library and find two research articles on community health nursing. In what settings did the research take place? Did the nursing authors collaborate with interdisciplinary team members on this research? If so, how do you think this collaboration helped the research? If you were to conduct research in the community, would you conduct it with only nurses on the team, or would your team be interdisciplinary? Why? What would be the benefits or limits of each approach?