Settings for Community Health Nursing .

1. Settings for Community Health Nursing. By Nataliya Haliyash, MD, BSN TSMU, International Nursing School

2. Lecture objectives: Upon finishing this lecture, you should be able to: • Describe seven settings in which community health nursespractice. • Discuss the nature of community health nursing, and the commonthreads basic to its practice, woven throughout all roles andsettings. • 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 healthnurses practice are increasingly varied and include a growingnumber of nontraditional settings and partnerships withnonhealth groups. • Employers of community health nursesrange from state and local health departments and homehealth agencies to managed care organizations, usinessesand industries, and nonprofit organizations.

12. Work settings for community health nurses Thesesettings are grouped into seven categories: • (1)homes, • (2) ambulatory service settings, • (3) schools, • (4) occupationalhealth 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 • Manycommunity health nursing visits focus on assisting familiesto understand and practice healthier living behaviors: • Nursesmay, for example, instruct clients on parenting, infant care,child discipline, • diet, exercise, • coping with stress, • or managinggrief and loss.

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

18. Home visits • anxiety for the nurse. • nurse’s first experienceoutside the acute care, long-term care, or clinic setting. • visitingfamilies in unfamiliar neighborhoods. • fear ofthe unknown. • collaborationwith various types of home careproviders, including hospitals, other nurses, physicians, rehabilitationtherapists, and durable medical equipment companies

19. Ambulatory service settings • include a variety of venues forcommunity health nursing practice in which clients come forday or evening services that do not include overnight stays. • Community health centers • Multipleclinics offering comprehensiveservices • Familyplanning clinics or a well-childclinics • Daycare centers, such as those for physicallydisabled or emotionally disturbed adults • Offices (for example, a communityhealth nurse associated with a health maintenance organizationsees clients in the office and undertakes screening, referrals,counseling, health education, and group work.

20. Ambulatory service settingscont • 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 forcommunity health nursing practice. • Community health nurses in occupational health settingspractice a variety of roles: • The clinician role was primary formany years, as nurses continued to care for sick or injuredemployeesat work. • However, recognition of the need to protectemployees’ safety and, later, to prevent their illness led to theinclusion of health education in the occupational health nurserole. • Occupational health nurses also act as employee advocates,assuring appropriate job assignments for workers andadequate treatment for job-related illness or injury.

23. Residential Institutions • Any facility where clients reside can be a setting in whichcommunity health nursing is practiced. • Residential institutions can include • a halfway house in which clients live temporarilywhile recovering from drug addiction, • an inpatienthospice program in which terminally ill clients live. • Someresidential settings, such as hospitals, exist solely to providehealth care; • others provide other services and support.

24. Residential Institutionscont • A continuing care centers: • In this setting, residents usually areelderly; some live quite independently, whereas others becomeincreasingly more dependent and have many chronichealth problems. • The community health nurse functions asadvocate and collaborator to improve services.

25. Residential Institutionscont • Residential institutions provide unique settings for thecommunity health nurse to practice health promotion. • Clients are a “captive” audience whose needs can be readilyassessed and whose interests can be stimulated. • These settingsoffer the opportunity to generate an environment of caringand optimal-quality health care provided by communityhealth nursing services.

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

27. Parish nursing • Involvesa large-scale effortby the church community to improve the health of itsmembers through education, screening, referral, treatment,and group support.

29. Community at Large • Unlike the six settings already discussed, the seventh settingfor community health nursing practice is not confined to aspecific philosophy, location, or building. When workingwith groups, populations, or the totalcommunity, the nursemay practice in many different places.

30. Community at Large For example, • A communityhealth nurse, as clinician and health educator, maywork with a parenting group in a church or town hall. • Anothernurse, as client advocate, leader, and researcher, maystudy the health needs of a neighborhood’s elderly populationby collecting data throughout the area and meeting withresource people in many places. • A nurse may work withcommunity-based organizations such as an AIDS organizationor a support group for parents experiencing the violentdeath of a child.

31. Tasks for practical • Search the Internet or go to the library and find two sources of health-related information for consumers. Was the information accurate? • 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?