Community – Based Nursing

1. Community – Based Nursing Lisa B. Flatt, RN, MSN, CHPN

2. Community Setting • Outside of the hospital or clinics • Typically in the home

3. Concepts • Community – social group (any size) • Located in same area • Shared government • Common goals: social, religious, occupations, at-risk population • Community-based health care- care in daily lives, holistic • Easy access • Flexible & supportive • Continuity of care in home and facility settings • Home care – visiting nurse • Easy access • Flexible & supportive • Continuity of care in home and facility settings

4. Community Functions • Production • Distribution • Consumption of goods • Socialization • Social control • Social interparticipation • Mutual support

5. Healthy Community (Kozier, et al 2000) • Group togetherness • Conserve natural resources • Subgroups, community participation • Crises preparation • Community problem solving • Open channels of communication • Community problem solving • Available resources • Dispute resolution • Group decision making • Wellness amongst members

6. Nurse’s Roles • Community-based – primary health care provider, not confined to community roles • Case manager – variety of nursing duties • Collaborator – other disciplines • Discharge planner – prepare for another level of care • Community health nurse – prevention, ie flu, epidemics, toxic exposure

7. Health Promotion • Primary prevention – ie. Condoms avoid _STD, kids_, eliminates risks that can be modified, another one is _vaccines prevent diseases, and diarrhea__ • Secondary prevention – health screening - _mammogram-breast cancer, Pap smear, HPV, education__, detects presence of predisposing factors • Tertiary prevention – treatment and rehab after a disease, __chemo, laser, radiation, abx___

8. Horton hears a WHO • Who is WHO: World Health Organization • What do they do: help the disadvantaged, 3rd world countries • HFA is Health For All • Health policies – travel and illness, flu shots • Social and economic development – bird flu, caging, awareness, s/s, education • Provision of health care – txment (isolated) • Health status – wellness, prevention • World Bank- $ allocation for basic needs, wells, water, shelter • Pan American Health Organization – Latin American, education, research and environment • American Red Cross – Clara Barton, RN – community health nurse ER preparedness, blood drives

9. We Got Here • CDC – Centers 4 disease control and prevention - education and statistics • FDA – Federal Drug Administration – regulation and legal implications • DHHS-Dep’t Health and Human Services • Soc Sec • HCFA Health care financing administration • Administration for kids and families – food stamps, WIC • Public Health Services – Medicare home care benefits

10. Medicare • Elderly (old farts) • 1988 – everyone over 65 y/o, disabled and dependents • Part A – hospitalization and home care, hospice • Part B – voluntary, dr. coverage, therapy under certain circumstances • All pay deductible and co-pay • No dental, no preventive stuff, no routine physical, no routine tests

11. Medicaid • Federal public assistance • Low income • Medicare and medicaid – elderly low income, needs med’s • Transplants, hemodialysis

12. DHHS: Health People 2010 National Health Promotion and Disease Prevention Objectives • Increase lifespan • Reduce health disparities, all Americans access to care • Decrease race-disparity in life expectancy – Black Americans, increased HTN, kidney disease, CVA

13. State Health Departments • All different • Rules and regulations • Health codes • Licensing • Manage own programs • Kids and MRDD • Local Health Dept’s • Small clinics, etc… flu shots, kid shots, BCP, condoms (?)

14. Three Levels of Community Health Care • Illness – sickie • Illness/disease prevention – shots, needle exchanges • Health promotion – education schools, community fairs

15. Epidemiology • Study of dx prevention • Occurrence, incidence, causes (OUTBREAK) • Infectious diseases • Epidemic – outbreaks of diseases, region • Pandemic – across countries (HIV) • Primary – promotion, prevention • Secondary – acute care, emergency care, dx and treatment • Tertiary – long term care, dying, rehabilitation

16. Terms • Frequency, incidence and prevalence – how often, when, where • Morbidity and mortality – death • Morbidity - # sick • Mortality - # died • Communicable diseases – diseases you catch, infectious, direct or indirect, airborne, droplet, contact

17. Kids, etc… • Infants and young kids – immunizations, prevention and education • Toddlers- eat weird things – paint • Chelation therapy(bld levels over 44, 70 ER) – metallic ion IV txment (Iron) • School-age kids – MVA’s, peer pressure, smoking, etc…

18. Kids, etc.. • Adolescent – preggers, peer pressure, eating disorders • Young adults – STD’s, weight control, smoking and ETOH • Middle aged – HTN • Older Adult – abuse • Developmental disabilities - community based care

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

20. Nursing Process • Pg 158-160