Community Health Nursing System and Process Unit 2

Community-based, Population-focused Health Care Delivery Definitions Community-based Nursing “ a philosophy of nursing that guides nursing care provided for individuals, families and groups wherever they are, … where they work, play, live or go to school.”

Definitions

Community-based Nursing

“ a philosophy of nursing that guides nursing care provided for individuals, families and groups wherever they are, … where they work, play, live or go to school.”

Community Health Nursing A specialty in nursing and an umbrella term. Some believe that CHN is synonymous with Public Health Nursing. “ A comprehensive and general practice that promotes and preserves the health of populations by integrating skills and knowledge relevant to both nursing and public health.”

A specialty in nursing and an umbrella term.

Some believe that CHN is synonymous with Public Health Nursing.

“ A comprehensive and general practice that promotes and preserves the health of populations by integrating skills and knowledge relevant to both nursing and public health.”

Population-based Nursing “ A wellness-oriented approach to practice.” “ directed toward identification of high-risk groups and collaboration with interdisciplinary teams to plan and coordinate programs . . that address actual and potential health problems.” Not to be confused with definitions of specific aggregates and total populations .

“ A wellness-oriented approach to practice.”

“ directed toward identification of high-risk groups and collaboration with interdisciplinary teams to plan and coordinate programs . . that address actual and potential health problems.”

Not to be confused with definitions of specific aggregates and total populations .

The Umbrella Concept of Community Health Nursing

The Home Visit “ Visit” or “visiting” definition: The verb implies action , “to go to see”. The noun implies an event , “a short stay”.

“ Visit” or “visiting” definition:

The verb implies action , “to go to see”.

The noun implies an event , “a short stay”.

“ Visiting”: Multiple meanings: Chatting with, influencing, observing, inspecting or investigating. May vary from formal to informal Social, spiritual, comfort, caring (as in charitable work, professional services and official, observational purposes). Outcomes may be positive (caring, helping, or comforting) Outcomes may be negative (afflicting, imposing, or harming)

Chatting with, influencing, observing, inspecting or investigating.

May vary from formal to informal

Social, spiritual, comfort, caring (as in charitable work, professional services and official, observational purposes).

Outcomes may be positive (caring, helping, or comforting)

Outcomes may be negative (afflicting, imposing, or harming)

The Emerging Concept of Home Visiting An antecedent event: The nurse becomes aware of the client or family needing or desiring a visit.

An antecedent event: The nurse becomes aware of the client or family needing or desiring a visit.

The Phases of Home Visiting The Contacting Phase Going to see Journey to home/family (community assessment) Approaching the family (knocking on the door)

The Contacting Phase

Going to see Journey to home/family (community assessment) Approaching the family (knocking on the door)

The Entry Phase Seeing Observing Experiencing Interacting

Seeing

Observing

Experiencing

Interacting

The Terminating Phase Telling Letting others know of family’s needs Realization of the need for social reform Documentation Referral

Telling

Letting others know of family’s needs

Realization of the need for social reform

Documentation

Referral

Other Concepts of Home Visiting More than just an alternative setting for service An intervention modality A modality for promoting family health A nursing intervention A process with distinct, labeled phases and specific nursing activities for each Entry involves not only gaining access to the client’s home but also entering into the client’s life situation A unique opportunity insight and understanding, when interacting in the client’s own environment Gaining appreciation for the client’s world view A feeling of shared humanity

More than just an alternative setting for service

An intervention modality

A modality for promoting family health

A nursing intervention

A process with distinct, labeled phases and specific nursing activities for each

Entry involves not only gaining access to the client’s home but also entering into the client’s life situation

A unique opportunity insight and understanding, when interacting in the client’s own environment

Gaining appreciation for the client’s world view

A feeling of shared humanity

The Referral Process Definition: “ A systematic problem-solving approach involving a series of actions that help clients to utilize resources for the purposes of resolving needs” Goal: The nurse directs the client to a service or resource, with the goal of promoting high level wellness and enhancing self-care capabilities and quality of care.

Definition:

“ A systematic problem-solving approach involving a series of actions that help clients to utilize resources for the purposes of resolving needs”

Goal:

The nurse directs the client to a service or resource, with the goal of promoting high level wellness and enhancing self-care capabilities and quality of care.

What does it take? It’s more than completing a form and telling the client to contact an agency. Knowledge of community resources Ability to problem-solve Set priorities Coordinate & Collaborate A “Referral System”

It’s more than completing a form and telling the client to contact an agency.

Knowledge of community resources

Ability to problem-solve

Set priorities

Coordinate & Collaborate

A “Referral System”

The referral should be: merited practical tailored to the client up to the client to say “yes” or “no” timely coordinated with other activities incorporated, so the client has input into the planning and implementation process.

merited

practical

tailored to the client

up to the client to say “yes” or “no”

timely

coordinated with other activities

incorporated, so the client has input into the planning and implementation process.

Steps of the Referral Process Establish a working relationship with the client Establish the need for the referral Set objectives for the referral Explore resource availability Remember that the client can choose whether or not to use the referral Make the referral to the resource Facilitate the referral Evaluate and follow-up

Establish a working relationship with the client

Establish the need for the referral

Set objectives for the referral

Explore resource availability

Remember that the client can choose whether or not to use the referral

Make the referral to the resource

Facilitate the referral

Evaluate and follow-up

Remember referral without follow-up is useless.

referral without follow-up is useless.

The Referral System Determine the types of services that will be needed Locate services in the community Collect information about the services (keep them current) Determine the appropriateness and quality of the services Develop a referral “list” Develop a referral protocol Develop a follow-up system Train people to make referrals Update the referral list and referral information

Determine the types of services that will be needed

Locate services in the community

Collect information about the services (keep them current)

Determine the appropriateness and quality of the services

Develop a referral “list”

Develop a referral protocol

Develop a follow-up system

Train people to make referrals

Update the referral list and referral information

Gain Access to Resources in the Community Important concepts: Agencies provide services that the nurse cannot. Referrals improve the client’s ability to initiate self-care. Referral information is usually out-of-date after the first time you make contact.

Important concepts:

Agencies provide services that the nurse cannot.

Referrals improve the client’s ability to initiate self-care.

Referral information is usually out-of-date after the first time you make contact.

Resource Files: Name, address, phone number, directions to the facility (i.e.: bus route, cross-street) Person in charge of the agency or contact person for client (this may be the “first person” who answers the phone or a specific individual). Purpose and services of the agency Eligibility criteria Application procedure Fee or payment schedule Date and initials of person compiling/updating the information

Name, address, phone number, directions to the facility (i.e.: bus route, cross-street)

Person in charge of the agency or contact person for client (this may be the “first person” who answers the phone or a specific individual).

Purpose and services of the agency

Eligibility criteria

Application procedure

Fee or payment schedule

Date and initials of person compiling/updating the information

Client-Oriented Roles “Involve direct provision of client services to individuals, families and occasionally groups” (Clark, 2003) One way of providing population based care

“Involve direct provision of client services to individuals, families and occasionally groups” (Clark, 2003)

One way of providing population based care

Client-Oriented Roles Caregiver Educator Counselor Referral resource Role model Advocate Primary care provider Case manager

Caregiver

Educator

Counselor

Referral resource

Role model

Advocate

Primary care provider

Case manager

Delivery-oriented Roles Enhances the operations of health care delivery and which results in better care for clients (Clark, 2003)

Enhances the operations of health care delivery and which results in better care for clients (Clark, 2003)

Delivery-oriented Roles Collaborator Coordinator/Care Manager Liaison

Collaborator

Coordinator/Care Manager

Liaison

Population-based Roles Differ from client and deliver oriented roles. (client & family focus) Actions/roles relate to populations and groups Changes in larger social and environmental factors that affect health (Clark, 2003)

Differ from client and deliver oriented roles. (client & family focus)

Actions/roles relate to populations and groups

Changes in larger social and environmental factors that affect health (Clark, 2003)

Tenets of Public Health Nursing Population-based assessment, policy development& assurance Partnering with representatives of the people Priority = Primary prevention Interventions are selected to increase healthy conditions in in the environment, society, & economics. Outreach to marginal and at-risk communities Greater good over individual-social justice Collaboration with other professions and organizations

Population-based assessment, policy development& assurance

Partnering with representatives of the people

Priority = Primary prevention

Interventions are selected to increase healthy conditions in in the environment, society, & economics.

Outreach to marginal and at-risk communities

Greater good over individual-social justice

Collaboration with other professions and organizations

Population-based Roles Case finder Leader Change Agent Community Developer Coalition Builder Researcher

Case finder

Leader

Change Agent

Community Developer

Coalition Builder

Researcher