Community – Based Nursing
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Transcript of Community – Based Nursing
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