Chapter 3 CommunityBased Nursing Practice Copyright 2017 Elsevier

Giddens Concepts Caregiving: a multidimensional concept that encompasses the action or process of helping

New Stimulus for Community-Based Nursing Practice Because patients spend less time in acute care settings, there is a growing need to have organized health care services where the population lives, works, and learns. As community health care partnerships develop, nurses are in a strategic position to play an important role in health care delivery and to improve the health of the community. Copyright © 2017, Elsevier Inc. All Rights Reserved. 3

Focus of Community-Based Nursing Health Promotion Disease Prevention Restorative Care Copyright © 2017, Elsevier

Community-Based Health Care A model of care to reach all in a community Ø Focuses on helping individuals and communities to create a healthy living environment Occurs outside of traditional health care facilities Provides services for acute and chronic conditions Copyright © 2017, Elsevier Inc. All Rights Reserved. 5

Community-Based Health Care (Cont. ) Public health problems influenced by: Political policy and the Affordable Care Act (ACA) Ø Social determinants of health Ø Increases in health disparities Ø Economics Ø Copyright © 2017, Elsevier Inc. All Rights Reserved. 6

Achieving Healthy Populations and Communities Healthy People Initiative (by USDHHS) Ø Establishes ongoing health care goals Healthy People 2020 Ø Goals are to increase life expectancy and quality of life, and to eliminate health disparities through improved delivery of health care services Copyright © 2017, Elsevier Inc. All Rights Reserved. 7

Improved Delivery of Health Care Improved delivery of health care occurs through Assessment of health care needs of individuals, families, and communities Ø Development and implementation of public health policies Ø Improved access to care Ø Copyright © 2017, Elsevier Inc. All Rights Reserved. 8

Social Determinants of Health Biology and genetics Individual behavior Social environment Physical environment Health

Health Disparities Negatively affect groups of people who have systematically experienced social or economic obstacles to health Preventable differences in the burden of disease, injury, violence, or opportunities to achieve optimal health that are experienced by socially disadvantaged populations Result from poverty, environmental threats, inadequate access to health care, individual and behavioral factors, and educational inequalities Copyright © 2017, Elsevier Inc. All Rights Reserved. 10

Community Health Nursing Public health nursing requires an understanding of Needs of a population Ø Factors that influence health promotion and health maintenance Ø Trends and patterns influencing disease within populations Ø Environmental factors contributing to health and illness Ø Political processes used to affect public policy Ø Copyright © 2017, Elsevier Inc. All Rights Reserved. 11

Community Health Nursing (Cont. ) Community health nursing Nursing practice in the community Ø Primary focus: health care of individuals, families, and groups within the community Ø Goal: preserve, protect, promote, or maintain health Ø Copyright © 2017, Elsevier Inc. All Rights Reserved. 12

Nursing Practice in Community Health Expert community health nurses: Understand the needs of a population or community Ø Use critical thinking skills to apply knowledge Ø Understand resources Ø Build relationships within the community Ø Are responsive to changes in the community Ø Copyright © 2017, Elsevier Inc. All Rights Reserved. 13

Community-Based Nursing Involves acute and chronic care Enhances individuals’ capacity for self-care Promotes autonomy Uses critical thinking Reduces costs Provides direct access to nurses Copyright © 2017, Elsevier Inc. All Rights Reserved. 14

Vulnerable Populations Individuals living in poverty Older adults People who are homeless Immigrant populations Individuals in abusive relationships Substance abusers People with severe mental illnesses Copyright © 2017, Elsevier Inc. All Rights Reserved. 15

Competency in Community-Based Nursing Nurses utilize a variety of skills and talents: Caregiver Case Manager Change Agent Patient Advocate Collaborator Counselor Educator Epidemiologist Copyright © 2017, Elsevier Inc. All Rights Reserved. 16

Community Assessment Components of community assessment Systematic data collection on the population Ø Monitoring the health status of the population Ø Making information available about the community’s health Ø Components of the community Structure or locale Ø People Ø Social systems Ø Assess individuals in the context of a community Copyright © 2017, Elsevier Inc. All Rights Reserved. 17

Community Assessment Structure Name of community or neighborhood Geographical boundaries Emergency services Water and sanitation Housing Economic status (e. g. , average household income, number of residents on public assistance) Transportation Population Age distribution Sex distribution Growth trends Density Education level Predominant ethnic groups Predominant religious groups Social System Education system Government Communication system Welfare system Volunteer programs Health system Copyright © 2017, Elsevier Inc. All Rights Reserved. 18

Changing Patients’ Health Establish strong, caring relationships with patients and their families Understand day-to-day activities of family life Design interventions to promote health and prevent disease Copyright © 2017, Elsevier Inc. All Rights Reserved. 19