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Unit%202%20 %20 Community%20 Health%20 Nursing%20system%20and%20process


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  • 1. Community Health Nursing System and Process Unit 2
  • 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.”
  • 3. 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.”
  • 4. 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 .
  • 5. The Umbrella Concept of Community Health Nursing
  • 6. The Home Visit
    • “ Visit” or “visiting” definition:
      • The verb implies action , “to go to see”.
      • The noun implies an event , “a short stay”.
  • 7. “ 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)
  • 8. The Emerging Concept of Home Visiting
    • An antecedent event: The nurse becomes aware of the client or family needing or desiring a visit.
  • 9. The Phases of Home Visiting
    • The Contacting Phase
      • Going to see Journey to home/family (community assessment) Approaching the family (knocking on the door)
  • 10. The Entry Phase
    • Seeing
    • Observing
    • Experiencing
    • Interacting
  • 11. The Terminating Phase
    • Telling
    • Letting others know of family’s needs
    • Realization of the need for social reform
    • Documentation
    • Referral
  • 12. 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
  • 13. 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.
  • 14. 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”
  • 15. 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.
  • 16. 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
  • 17. Remember
    • referral without follow-up is useless.
  • 18. 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
  • 19. 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.
  • 20. 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
  • 21. Client-Oriented Roles
    • “Involve direct provision of client services to individuals, families and occasionally groups” (Clark, 2003)
    • One way of providing population based care
  • 22. Client-Oriented Roles
    • Caregiver
    • Educator
    • Counselor
    • Referral resource
    • Role model
    • Advocate
    • Primary care provider
    • Case manager
  • 23. Delivery-oriented Roles
    • Enhances the operations of health care delivery and which results in better care for clients (Clark, 2003)
  • 24. Delivery-oriented Roles
    • Collaborator
    • Coordinator/Care Manager
    • Liaison
  • 25. 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)
  • 26. 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
  • 27. Population-based Roles
    • Case finder
    • Leader
    • Change Agent
    • Community Developer
    • Coalition Builder
    • Researcher