Community – Based Community – Based NursingNursing

Lisa B. Flatt, RN, MSN, Lisa B. Flatt, RN, MSN, CHPNCHPN

Community SettingCommunity Setting

Outside of the hospital or clinicsOutside of the hospital or clinics Typically in the homeTypically in the home

ConceptsConcepts Community – social group (any size)Community – social group (any size)

– Located in same areaLocated in same area– Shared governmentShared government– Common goals: social, religious, occupations, at-risk Common goals: social, religious, occupations, at-risk

populationpopulation Community-based health care- care in daily lives, Community-based health care- care in daily lives,

holisticholistic– Easy accessEasy access– Flexible & supportiveFlexible & supportive– Continuity of care in home and facility settingsContinuity of care in home and facility settings

Home care – visiting nurseHome care – visiting nurse– Easy accessEasy access– Flexible & supportiveFlexible & supportive– Continuity of care in home and facility settingsContinuity of care in home and facility settings

Community FunctionsCommunity Functions

ProductionProduction DistributionDistribution Consumption of goodsConsumption of goods SocializationSocialization Social controlSocial control Social interparticipationSocial interparticipation Mutual supportMutual support

Healthy Community (Kozier, et al Healthy Community (Kozier, et al 2000)2000)

Group togethernessGroup togetherness Conserve natural resourcesConserve natural resources Subgroups, community participationSubgroups, community participation Crises preparationCrises preparation Community problem solvingCommunity problem solving Open channels of communicationOpen channels of communication Community problem solvingCommunity problem solving Available resourcesAvailable resources Dispute resolutionDispute resolution Group decision makingGroup decision making Wellness amongst membersWellness amongst members

Nurse’s RolesNurse’s Roles

Community-based – primary health care Community-based – primary health care provider, not confined to community rolesprovider, not confined to community roles

Case manager – variety of nursing dutiesCase manager – variety of nursing duties Collaborator – other disciplinesCollaborator – other disciplines Discharge planner – prepare for another Discharge planner – prepare for another

level of carelevel of care Community health nurse – prevention, ie Community health nurse – prevention, ie

flu, epidemics, toxic exposureflu, epidemics, toxic exposure

Health PromotionHealth Promotion

Primary prevention – ie. Condoms avoid Primary prevention – ie. Condoms avoid _STD, kids_, eliminates risks that can be _STD, kids_, eliminates risks that can be modified, another one is _vaccines prevent modified, another one is _vaccines prevent diseases, and diarrhea__diseases, and diarrhea__

Secondary prevention – health screening - Secondary prevention – health screening - _mammogram-breast cancer, Pap smear, _mammogram-breast cancer, Pap smear, HPV, education__, detects presence of HPV, education__, detects presence of predisposing factorspredisposing factors

Tertiary prevention – treatment and rehab Tertiary prevention – treatment and rehab after a disease, __chemo, laser, radiation, after a disease, __chemo, laser, radiation, abx___abx___

Horton hears a WHOHorton hears a WHO Who is WHO: World Health OrganizationWho is WHO: World Health Organization What do they do: help the disadvantaged, 3What do they do: help the disadvantaged, 3rdrd world world

countriescountries HFA is Health For AllHFA is Health For All

– Health policies – travel and illness, flu shotsHealth policies – travel and illness, flu shots– Social and economic development – bird flu, caging, Social and economic development – bird flu, caging,

awareness, s/s, educationawareness, s/s, education– Provision of health care – txment (isolated)Provision of health care – txment (isolated)– Health status – wellness, preventionHealth status – wellness, prevention

World Bank- $ allocation for basic needs, wells, water, World Bank- $ allocation for basic needs, wells, water, sheltershelter

Pan American Health Organization – Latin American, Pan American Health Organization – Latin American, education, research and environmenteducation, research and environment

American Red Cross – Clara Barton, RN – community health American Red Cross – Clara Barton, RN – community health nurse ER preparedness, blood drivesnurse ER preparedness, blood drives

We Got HereWe Got Here

CDC – Centers 4 disease control and CDC – Centers 4 disease control and prevention - education and statisticsprevention - education and statistics

FDA – Federal Drug Administration – FDA – Federal Drug Administration – regulation and legal implicationsregulation and legal implications

DHHS-Dep’t Health and Human ServicesDHHS-Dep’t Health and Human Services– Soc SecSoc Sec– HCFA Health care financing administrationHCFA Health care financing administration– Administration for kids and families – food Administration for kids and families – food

stamps, WICstamps, WIC– Public Health Services – Medicare home care Public Health Services – Medicare home care

benefitsbenefits

MedicareMedicare

Elderly (old farts)Elderly (old farts) 1988 – everyone over 65 y/o, disabled and 1988 – everyone over 65 y/o, disabled and

dependentsdependents– Part A – hospitalization and home care, hospicePart A – hospitalization and home care, hospice– Part B – voluntary, dr. coverage, therapy under Part B – voluntary, dr. coverage, therapy under

certain circumstancescertain circumstances– All pay deductible and co-payAll pay deductible and co-pay– No dental, no preventive stuff, no routine No dental, no preventive stuff, no routine

physical, no routine testsphysical, no routine tests

MedicaidMedicaid

Federal public assistanceFederal public assistance Low incomeLow income Medicare and medicaid – elderly low Medicare and medicaid – elderly low

income, needs med’sincome, needs med’s Transplants, hemodialysisTransplants, hemodialysis

DHHS: Health People 2010 DHHS: Health People 2010 National Health Promotion and National Health Promotion and Disease Prevention ObjectivesDisease Prevention Objectives

Increase lifespanIncrease lifespan Reduce health disparities, all Reduce health disparities, all

Americans access to careAmericans access to care Decrease race-disparity in life Decrease race-disparity in life

expectancy – Black Americans, expectancy – Black Americans, increased HTN, kidney disease, CVAincreased HTN, kidney disease, CVA

State Health DepartmentsState Health Departments

All differentAll different Rules and regulationsRules and regulations Health codesHealth codes LicensingLicensing Manage own programsManage own programs Kids and MRDDKids and MRDD Local Health Dept’sLocal Health Dept’s

– Small clinics, etc… flu shots, kid shots, BCP, Small clinics, etc… flu shots, kid shots, BCP, condoms (?)condoms (?)

Three Levels of Community Health Three Levels of Community Health CareCare

Illness – sickieIllness – sickie Illness/disease prevention – shots, Illness/disease prevention – shots,

needle exchangesneedle exchanges Health promotion – education Health promotion – education

schools, community fairsschools, community fairs

EpidemiologyEpidemiology Study of dx preventionStudy of dx prevention Occurrence, incidence, causes Occurrence, incidence, causes

(OUTBREAK)(OUTBREAK) Infectious diseasesInfectious diseases Epidemic – outbreaks of diseases, regionEpidemic – outbreaks of diseases, region Pandemic – across countries (HIV)Pandemic – across countries (HIV) Primary – promotion, preventionPrimary – promotion, prevention Secondary – acute care, emergency care, Secondary – acute care, emergency care,

dx and treatmentdx and treatment Tertiary – long term care, dying, Tertiary – long term care, dying,

rehabilitationrehabilitation

TermsTerms

Frequency, incidence and prevalence Frequency, incidence and prevalence – how often, when, where– how often, when, where

Morbidity and mortality – deathMorbidity and mortality – death– Morbidity - # sickMorbidity - # sick– Mortality - # diedMortality - # died– Communicable diseases – diseases you Communicable diseases – diseases you

catch, infectious, direct or indirect, catch, infectious, direct or indirect, airborne, droplet, contactairborne, droplet, contact

Kids, etc…Kids, etc…

Infants and young kids – Infants and young kids – immunizations, prevention and immunizations, prevention and educationeducation

Toddlers- eat weird things – paintToddlers- eat weird things – paint– Chelation therapy(bld levels over 44, 70 Chelation therapy(bld levels over 44, 70

ER) – metallic ion IV txment (Iron)ER) – metallic ion IV txment (Iron)– School-age kids – MVA’s, peer pressure, School-age kids – MVA’s, peer pressure,

smoking, etc…smoking, etc…

Kids, etc..Kids, etc..

Adolescent – preggers, peer Adolescent – preggers, peer pressure, eating disorderspressure, eating disorders

Young adults – STD’s, weight control, Young adults – STD’s, weight control, smoking and ETOHsmoking and ETOH

Middle aged – HTNMiddle aged – HTN Older Adult – abuseOlder Adult – abuse Developmental disabilities - Developmental disabilities -

community based carecommunity based care

Family IssuesFamily Issues Violence – increase need for health careViolence – increase need for health care DysfunctionDysfunction DivorceDivorce Disrupted – foster care, militaryDisrupted – foster care, military Ineffective parenting skills – immature, mental illness, physical illIneffective parenting skills – immature, mental illness, physical ill Educational levels – Educational levels – Socioeconomic status – immigration, illegal or legal, poverty and access to careSocioeconomic status – immigration, illegal or legal, poverty and access to care Lifestyle, health habits – eating McD’sLifestyle, health habits – eating McD’s Physical conditions – coach roaches in homes =asthmaPhysical conditions – coach roaches in homes =asthma Family nutrition risks – food stamps, hoardersFamily nutrition risks – food stamps, hoarders Maternal child health – cornerstone of healthMaternal child health – cornerstone of health Substance abuse – poor nutrition, sell for drugsSubstance abuse – poor nutrition, sell for drugs Cultural/spiritual/religious beliefsCultural/spiritual/religious beliefs Community beliefsCommunity beliefs Health expectationsHealth expectations Environmental – homeless, ER plans, waste disposal, sanitationEnvironmental – homeless, ER plans, waste disposal, sanitation Psychological – PTSD, depression, anxietyPsychological – PTSD, depression, anxiety Ethnic caregivers/community based – midwives, shamans, etc….Ethnic caregivers/community based – midwives, shamans, etc….

Nursing ProcessNursing Process

Pg 158-160Pg 158-160