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  • 1. Chapter 2 Community-Based Nursing PracticeCopyright © 2010 Wolters Kluwer Health | Lippincott Williams & Wilkins
  • 2. Factors that Have Increased the Need forCommunity Health Care• Changes in federal legislation• Tighter insurance regulations• Decreasing health revenues• Alternative health care delivery systems Copyright © 2010 Wolters Kluwer Health | Lippincott Williams & Wilkins
  • 3. Primary Concepts of Community-BasedCare• Promotion of self-care• Preventive care within content of community, culture• Continuity of care• Collaboration Copyright © 2010 Wolters Kluwer Health | Lippincott Williams & Wilkins
  • 4. Question• The shift in health care delivery from acute care to community based case is primarily the result ofA.alternative health care delivery systems.B.insurance regulations changes.C.federal legislation changes.D.combination of these three items. Copyright © 2010 Wolters Kluwer Health | Lippincott Williams & Wilkins
  • 5. Answer• D. Combination of alternative health care delivery systems, insurance regulations changes, federal legislation changes• Rationale: Changes in federal legislation, tighter insurance regulations, decreasing hospital revenues, and alternative health care delivery systems all have affected the ways in which health care is delivered. Copyright © 2010 Wolters Kluwer Health | Lippincott Williams & Wilkins
  • 6. Levels of Preventive Care• Primary• Secondary• Tertiary Copyright © 2010 Wolters Kluwer Health | Lippincott Williams & Wilkins
  • 7. Community Health Settings• Public health departments• Various clinics• Industrial, occupational nursing• School nursing• Home health care Copyright © 2010 Wolters Kluwer Health | Lippincott Williams & Wilkins
  • 8. Home Health Care• Becoming one of largest areas of practice for nurses• Collaborative, interdisciplinary• Holistic Copyright © 2010 Wolters Kluwer Health | Lippincott Williams & Wilkins
  • 9. Community Nursing Differs from Hospital-Based Nursing• Community nurses care for individuals, families, groups outside hospital setting• Nurse is guest coming into patient home or community setting• Nurse may provide – Direct care – Resources or advocacy to larger group in community setting Copyright © 2010 Wolters Kluwer Health | Lippincott Williams & Wilkins
  • 10. Community Nursing• Nurses have little control over care environment• Little on-site support or supervision available• Supplies, resources may not be available Copyright © 2010 Wolters Kluwer Health | Lippincott Williams & Wilkins
  • 11. Nurses Functioning in the CommunityMust• Be – Self-directed – Flexible – Critical thinkers – Independent decision makers – Culturally competent Copyright © 2010 Wolters Kluwer Health | Lippincott Williams & Wilkins
  • 12. Nurses Functioning in the CommunityMust (cont’d)• Have – Basic nursing care competencies – Excellent assessment skills – Good abilities to provide health education Copyright © 2010 Wolters Kluwer Health | Lippincott Williams & Wilkins
  • 13. Question• Tell whether the following statement is true or false:• A common element of a nurse working in community- based case is the focus on the needs of the individual. Copyright © 2010 Wolters Kluwer Health | Lippincott Williams & Wilkins
  • 14. Answer• False.• Rationale: A common element in all the roles of the nurse working in community-based care is the focus upon community needs as well as the needs of the individual or the family. Copyright © 2010 Wolters Kluwer Health | Lippincott Williams & Wilkins
  • 15. Discharge Planning• Transition from acute care to home care• Collaborative• Required for reimbursement by Medicare Copyright © 2010 Wolters Kluwer Health | Lippincott Williams & Wilkins
  • 16. Identifying Resources and MakingReferrals• Directories• Phone book• Interdisciplinary collaboration Copyright © 2010 Wolters Kluwer Health | Lippincott Williams & Wilkins
  • 17. The Home Health Visit: Preparation• Review agency policies, procedures• Review referral forms, other appropriate records – Discharge plan of care• Call, arrange appointment• Always ask permission, explain purpose, goals to patient Copyright © 2010 Wolters Kluwer Health | Lippincott Williams & Wilkins
  • 18. Assessing the Need for Home Visitss• Current health status• Home environment• Level of self-care ability• Level of nursing care needed• Prognosis• Educational needs• Mental status• Level of adherence Copyright © 2010 Wolters Kluwer Health | Lippincott Williams & Wilkins
  • 19. Conducting the Home Health Visit• Personal safety precautions• Initial home visit• Determining need for future visits• Ending visit Copyright © 2010 Wolters Kluwer Health | Lippincott Williams & Wilkins
  • 20. Community Based Health Care Settings• Ambulatory settings• Occupational health programs• School health programs• Community nurse–managed centers• Care for homeless Copyright © 2010 Wolters Kluwer Health | Lippincott Williams & Wilkins
  • 21. Question• Tell whether the following statement is true or false:• During the initial home visit, the patient is evaluated and a plan of care is established. Copyright © 2010 Wolters Kluwer Health | Lippincott Williams & Wilkins
  • 22. Answer• True.• Rationale: During the initial home visit, the patient is evaluated and a plan of care is established. The initial assessment includes evaluating the patient, the home environment, the patient’s self-care abilities or the family’s ability to provide care, and the patient’s need for additional resources. Copyright © 2010 Wolters Kluwer Health | Lippincott Williams & Wilkins