Chapter 1 Overview of CommunityBased Nursing Copyright 2009

Future of Nursing: Trends to Watch • Changing demographics and increasing diversity • The technology explosion • Globalization • Educated consumers Copyright © 2009 Wolters Kluwer Health | Lippincott Williams & Wilkins

Future of Nursing: Trends (con’t) • Shift to population-based care and increased complexity of care • Higher costs and challenges of managed care • Effects of health policy and regulation • Need for interdisciplinary education and collaborative care Copyright © 2009 Wolters Kluwer Health | Lippincott Williams & Wilkins

Future of Nursing : Trends (con’t) • Nursing shortage • Lifelong learning • Advances

Community-Based Care: Philosophy of Care or Setting for Practice? • Providing care with an emphasis on community and home care is not a new concept for nursing. • Until the early 1900 s, nurses usually practiced in homes and communities. Copyright © 2009 Wolters Kluwer Health | Lippincott Williams & Wilkins

National League for Nursing’s Essential Components of Community Care • Self-care • Prevention • Consideration of family, culture, and community • Continuity of care through collaboration Copyright © 2009 Wolters Kluwer Health | Lippincott Williams & Wilkins

Misconceptions About Community Care • There are two types of nurses: those who work in the community and those who work in hospitals. • Community-based nursing describes a setting for practice. • Nursing in the community requires skills and knowledge different from those needed in the acute care setting. Copyright © 2009 Wolters Kluwer Health | Lippincott Williams & Wilkins

Question Who said the nurse, through her “peculiar introduction to the patient and her organic relationship with the neighborhood” could be the “starting point” for wider service in the community? A. Mary Brewster B. William Rathbone C. Lillian Wald D. Florence Nightingale Copyright © 2009 Wolters Kluwer Health | Lippincott Williams & Wilkins

Answer C. Lillian Wald, the founder of public health nursing, drew on contemporary ideas that linked nursing, motherhood, social welfare, and the public. Her work was designed to respond to the needs of those populations at greatest risk by nursing the sick in their homes and providing preventive instructions to reduce illness. Copyright © 2009 Wolters Kluwer Health | Lippincott Williams & Wilkins

Question Which of the following describes the trend in location of practice in community-based nursing over the last century? A. In the early 1900 s, 90% of nursing care was provided in the community. B. There was an abrupt shift to provide nursing care in the hospital after World War II and the discovery of penicillin. C. In the early 1980 s, federal legislation was implemented to encourage more hospital care. D. The trend of providing more care in the hospital has continued into the 21 st century. Copyright © 2009 Wolters Kluwer Health | Lippincott Williams & Wilkins

Answer A. In the early 1900 s, 90% of nursing care was provided in the community. Nursing care provided in the home in the early 1900 s migrated to the acute care hospital in the middle of the 20 th century, and then back to the home in the 1980 s. After 1980, this trend intensified as the number of nurses working in public and community health, ambulatory care, and other institutional settings increased rapidly (Health Resources and Services Administration [HRSA], 2005). Copyright © 2009 Wolters Kluwer Health | Lippincott Williams & Wilkins

Question How is community defined? A. People B. Location C. Social system D. All

Answer D. All of the above According to the definition in the textbook, community is defined by “people, locations, and social systems” (Josten, 1989). Copyright © 2009 Wolters Kluwer Health | Lippincott Williams & Wilkins

Question Which of the following are characteristics of a healthy community? A. Magnet hospitals with premier surgical procedures available B. Preparation to meet crises C. Quickest first-responder service in the region D. A safe environment E. Choices B and D Copyright © 2009 Wolters Kluwer Health | Lippincott Williams & Wilkins

Answer E. Choices B and D Healthy communities have the following characteristics (see next

Answer (cont’d) • Access to health care services that focus on both treatment and prevention for all members of the community • A safe environment • Roads, schools, playgrounds, and other services to meet the needs of the people in that community • Participation of subgroups in community affairs Copyright © 2009 Wolters Kluwer Health | Lippincott Williams & Wilkins

Answer (cont’d) • Emergency preparedness • Ability to solve problems • Communication through open channels • Settling of disputes through legitimate mechanisms • Participation by citizens in decision making • A high degree of wellness among its citizens Copyright © 2009 Wolters Kluwer Health | Lippincott Williams & Wilkins

The Principles of Community Care • Advocating self-care • Focusing on prevention • Family, culture, and community • Continuity of care • Collaborative care Copyright © 2009 Wolters Kluwer Health | Lippincott Williams & Wilkins