community based nursing practice

Chapter 2

Community-Based
Nursing Practice

Copyright © 2010 Wolters Kluwer Health | Lippincott Williams & Wilkins

Factors that Have Increased the Need for
Community Health Care
• Changes in federal legislation
• Tighter insurance regulations
• Decreasing health revenues
• Alternative health care delivery systems


Primary Concepts of Community-Based
Care
• Promotion of self-care
• Preventive care within content of community, culture
• Continuity of care
• Collaboration


Question
• The shift in health care delivery from acute care to
community based case is primarily the result of
A.alternative health care delivery systems.
B.insurance regulations changes.
C.federal legislation changes.
D.combination of these three items.


Answer
• D. Combination of alternative health care delivery
systems, insurance regulations changes, federal
legislation changes
• Rationale: Changes in federal legislation, tighter
insurance regulations, decreasing hospital revenues, and
alternative health care delivery systems all have affected
the ways in which health care is delivered.


Levels of Preventive Care
• Primary
• Secondary
• Tertiary


Community Health Settings
• Public health departments
• Various clinics
• Industrial, occupational nursing
• School nursing
• Home health care


Home Health Care
• Becoming one of largest areas of practice for nurses
• Collaborative, interdisciplinary
• Holistic


Community Nursing Differs from Hospital-
Based Nursing
• Community nurses care for individuals, families, groups
outside hospital setting
• Nurse is guest coming into patient home or community
setting
• Nurse may provide
– Direct care
– Resources or advocacy to larger group in community
setting


Community Nursing
• Nurses have little control over care environment
• Little on-site support or supervision available
• Supplies, resources may not be available


Nurses Functioning in the Community
Must
• Be
– Self-directed
– Flexible
– Critical thinkers
– Independent decision makers
– Culturally competent


Nurses Functioning in the Community
Must (cont’d)
• Have
– Basic nursing care competencies
– Excellent assessment skills
– Good abilities to provide health education


Question
• Tell whether the following statement is true or false:
• A common element of a nurse working in community-
based case is the focus on the needs of the individual.


Answer
• False.
• Rationale: A common element in all the roles of the nurse
working in community-based care is the focus upon
community needs as well as the needs of the individual
or the family.


Discharge Planning
• Transition from acute care to home care
• Collaborative
• Required for reimbursement by Medicare


Identifying Resources and Making
Referrals
• Directories
• Phone book
• Interdisciplinary collaboration


The Home Health Visit: Preparation
• Review agency policies, procedures
• Review referral forms, other appropriate records
– Discharge plan of care
• Call, arrange appointment
• Always ask permission, explain purpose, goals to patient


Assessing the Need for Home Visitss
• Current health status
• Home environment
• Level of self-care ability
• Level of nursing care needed
• Prognosis
• Educational needs
• Mental status
• Level of adherence


Conducting the Home Health Visit
• Personal safety precautions
• Initial home visit
• Determining need for future visits
• Ending visit


Community Based Health Care Settings
• Ambulatory settings
• Occupational health programs
• School health programs
• Community nurse–managed centers
• Care for homeless


Question
• Tell whether the following statement is true or false:
• During the initial home visit, the patient is evaluated and
a plan of care is established.


Answer
• True.
• Rationale: During the initial home visit, the patient is
evaluated and a plan of care is established. The initial
assessment includes evaluating the patient, the home
environment, the patient’s self-care abilities or the
family’s ability to provide care, and the patient’s need for
additional resources.


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