1. Copyright © 2013, 2009, 2005 by Mosby, an imprint of Elsevier Inc. Chapter 3 Community-Based Nursing Practice

2. 2Copyright © 2013, 2009, 2005 by Mosby, an imprint of Elsevier Inc. New Stimulus for Community-Based Nursing Practice   Because patients spend less time in acute care settings, there is a growing need to have organized health care services where the population lives, works, and learns.   As community health care partnerships develop, nursing is in a strategic position to play an important role in health care delivery and to improve the health of the community.

3. 3Copyright © 2013, 2009, 2005 by Mosby, an imprint of Elsevier Inc. Focus of Community-Based Nursing Health Promotion Disease Prevention Restorative Care

4. 4Copyright © 2013, 2009, 2005 by Mosby, an imprint of Elsevier Inc. Community-Based Health Care   A model of care to reach all in a community   Focuses on assisting individuals and communities with achieving a healthy living environment   Occurs outside of traditional health care facilities   Provides services for acute and chronic conditions

5. 5Copyright © 2013, 2009, 2005 by Mosby, an imprint of Elsevier Inc. Challenges   Public health problems influenced by:   Social lifestyles   Political policy   Economic initiatives   Current medical and social problems

6. 6Copyright © 2013, 2009, 2005 by Mosby, an imprint of Elsevier Inc. Achieving Healthy Populations and Communities   Healthy People Initiative (by USDHHS)   Establishes ongoing health care goals   Healthy People 2020   Goals are to increase life expectancy and quality of life, and to eliminate health disparities through improved delivery of health care services

7. 7Copyright © 2013, 2009, 2005 by Mosby, an imprint of Elsevier Inc. Improved Delivery of Health Care   Improved delivery of health care occurs through 1. Assessment of health care needs of individuals, families, and communities 2. Development and implementation of public health policies 3. Improved access to care

8. 8Copyright © 2013, 2009, 2005 by Mosby, an imprint of Elsevier Inc. Assessment   Examples:   Systematic data collection (such as incident rates) on the population   Monitoring the health status of the population   Accessing available information about the health of the community   Examples of program results:   Adolescent smoking prevention   Sex education   Proper nutrition

9. 9Copyright © 2013, 2009, 2005 by Mosby, an imprint of Elsevier Inc. Public Health Policy Development + Implementation   Health professionals provide leadership in   Developing public policies to support the health of a population   Strong policies are driven by community assessment:   Example: Assessment of level of lead poisoning in young children   Example: Assessment of the number of people in the community who need end-of-life care

10. 10Copyright © 2013, 2009, 2005 by Mosby, an imprint of Elsevier Inc. Improved Access to Care   Ensures that community-wide health services are   Available to the total community   Accessible to the total community   Example: Five-level Health Services Pyramid   Role of community services near acute care services   Healthy environments

11. 11Copyright © 2013, 2009, 2005 by Mosby, an imprint of Elsevier Inc. Case Study   Kim Callahan is a student in a community health nursing course. She is working in a community nursing service within a large city. Most of the patients in this agency are Bosnian immigrants.   A major care initiative in this agency is to provide well-child examinations and immunizations to get children ready to enter the public school system.

12. 12Copyright © 2013, 2009, 2005 by Mosby, an imprint of Elsevier Inc. Community Health Nursing   Nursing practice in the community   Primary focus is on health care of individuals, families, and groups.   Similar to public health nursing   Requires   Understanding the needs of a population   A set of skills and knowledge

13. 13Copyright © 2013, 2009, 2005 by Mosby, an imprint of Elsevier Inc. Community Health Nursing (cont’d)   Essential public health functions:   Community assessment   Policy development   Access to resources   Goal is to preserve, protect, promote, or maintain health.   Provides direct care services to subpopulations in a community   Competencies needed

14. 14Copyright © 2013, 2009, 2005 by Mosby, an imprint of Elsevier Inc. Nursing Practice in Community Health   Expert community health nurses:   Understand the needs of a population or community   Use critical thinking skills to apply knowledge   Understand resources   Needed skills:   Patient advocacy   Communicating people’s concerns   Designing new systems that cooperate with existing systems

15. 15Copyright © 2013, 2009, 2005 by Mosby, an imprint of Elsevier Inc. “Double Vision”   Community health nurses:   Successful practice involves:   Building relationships with the community   Being responsive to changes within the community Care for the community as a whole Assess the individual or family within the context of the community

16. 16Copyright © 2013, 2009, 2005 by Mosby, an imprint of Elsevier Inc. Community-Based Nursing   Occurs in community settings   Involves acute and chronic care   Enhances individuals’ capacity for self-care   Promotes autonomy in decision making   Uses critical thinking skills   Reduces costs for the patient by providing care near homes   Requires knowledge of family theory, communication, group dynamics, and cultural diversity

17. 17Copyright © 2013, 2009, 2005 by Mosby, an imprint of Elsevier Inc. Vulnerable Populations   Examples:   Immigrants   Poor and homeless   Abused   Substance abusers   Mentally ill   Older adults   Special needs of vulnerable populations are a challenge.

18. 18Copyright © 2013, 2009, 2005 by Mosby, an imprint of Elsevier Inc. Multilevel Intervention

19. 19Copyright © 2013, 2009, 2005 by Mosby, an imprint of Elsevier Inc. Case Study (cont’d)   Kim and her classmates conducted an assessment of the community’s health care needs and practices.   This is a close community that is facing many challenges, although chronic disease is absent in this population.   General preventive health care practices, including well examinations and basic screenings, are lacking.

20. 20Copyright © 2013, 2009, 2005 by Mosby, an imprint of Elsevier Inc. Competency in Community-Based Nursing   Competency is based on decision making at the level of the individual patient.

21. 21Copyright © 2013, 2009, 2005 by Mosby, an imprint of Elsevier Inc. Competency in Community-Based Nursing (cont’d)   Nurses utilize a variety of skills and talents: CaregiverCase Manager Change AgentPatient Advocate CollaboratorCounselor EducatorEpidemiologist

22. 22Copyright © 2013, 2009, 2005 by Mosby, an imprint of Elsevier Inc. Quick Quiz! 1.Vulnerable populations of patients are those who are more likely to develop health problems as a result of A. Living at home. B. Abusive habits. C. Immigration. D. Middle age.

23. 23Copyright © 2013, 2009, 2005 by Mosby, an imprint of Elsevier Inc. Case Study (cont’d)   Many members of the Bosnian community are suspicious of free/low-cost care.   Kim attends community meetings with her community nurse preceptor to assess the beliefs and concerns of the community.   Misunderstandings and fears about health care services in this country are identified.   Kim uses beneficence—wanting to do the most good for the most people.   Kim respects the community’s beliefs.

24. 24Copyright © 2013, 2009, 2005 by Mosby, an imprint of Elsevier Inc. Community Assessment   Assesses the community at large   Nurses care for patients from diverse backgrounds and settings, but all communities have three components: Structure or Locale People Social Systems

25. 25Copyright © 2013, 2009, 2005 by Mosby, an imprint of Elsevier Inc. Case Study (cont’d)   One single-parent family in the community is 30-year- old Katrina Dudek and her two children (aged 3 years and 6 months).   Kim and the community health nurse work with Mrs. Dudek to determine the health care needs of her children and herself.   So far, Mrs. Dudek and her children have not received any care.   Kim and Mrs. Dudek discuss the need for immunizations of the children and set that as a goal.

26. 26Copyright © 2013, 2009, 2005 by Mosby, an imprint of Elsevier Inc. Quick Quiz! 2. In identifying needs for health policy and health program development and services, a community assessment focuses on which of the following elements? A. Structure B. People C. Social systems D. Environments E. All of the above

27. 27Copyright © 2013, 2009, 2005 by Mosby, an imprint of Elsevier Inc. Changing Patients’ Health   Nurses need an accurate assessment of patients to design interventions that promote health and prevent disease.   Patients are more likely to accept a change if it is: More AdvantageousCompatible RealisticEasy to Adopt

28. 28Copyright © 2013, 2009, 2005 by Mosby, an imprint of Elsevier Inc. Case Study (cont’d)   Kim identifies community leaders to serve as key persons in educational programs.   Kim spends 12 weeks working with the community agency and leaders to explain how the clinic provides services and the confidentiality of these services.   Kim presented information in three homes as well.   A gradual increase was noted in the use of services, including fewer “missed” appointments.