KOZIER ERBS Fundamentals of NURSING NINTH EDITION Concepts
KOZIER & ERB’S Fundamentals of NURSING NINTH EDITION Concepts, Process, and Practice CHAPTER 7 Community Nursing and Care Continuity Kozier & Erb’s Fundamentals of Nursing: Concepts, Process, and Practice, Ninth Edition Audrey Berman • Shirlee Snyder Copyright © 2012 by Pearson Education, Inc. All rights reserved.
Directory • Classroom Response System Questions • Lecture Note Presentation Kozier & Erb’s Fundamentals of Nursing: Concepts, Process, and Practice, Ninth Edition Audrey Berman • Shirlee Snyder Copyright © 2012 by Pearson Education, Inc. All rights reserved.
Classroom Response System Questions Kozier & Erb’s Fundamentals of Nursing: Concepts, Process, and Practice, Ninth Edition Audrey Berman • Shirlee Snyder Copyright © 2012 by Pearson Education, Inc. All rights reserved.
Question 1 The ANA’s Health System Reform Agenda (2008) included which of the following? A. Primary health care should be based in acute care hospitals. B. A minimum standard of health care for all persons should be paid for completely with public funds. C. Case management should be focused on clients with enduring health care needs. D. Essential services should be initiated simultaneously to avoid gaps. Kozier & Erb’s Fundamentals of Nursing: Concepts, Process, and Practice, Ninth Edition Audrey Berman • Shirlee Snyder Copyright © 2012 by Pearson Education, Inc. All rights reserved.
Question 1 Answer A. Primary health care should be based in acute care hospitals. B. A minimum standard of health care for all persons should be paid for completely with public funds. C. Case management should be focused on clients with enduring health care needs. D. Essential services should be initiated simultaneously to avoid gaps. Kozier & Erb’s Fundamentals of Nursing: Concepts, Process, and Practice, Ninth Edition Audrey Berman • Shirlee Snyder Copyright © 2012 by Pearson Education, Inc. All rights reserved.
Question 1 Rationales A. Incorrect. The ANA’s 2008 Agenda for Healthcare Reform addresses case management of clients with ongoing health care needs. B. Incorrect. C. Correct. Nursing’s Agenda for Healthcare Reform (ANA, 2008) called for case management of those with ongoing health care needs. It also proposed that primary care be community based but that essential services be paid for by a combination of public and private funding sources (not just public funds) and be phased in gradually. D. Incorrect. Kozier & Erb’s Fundamentals of Nursing: Concepts, Process, and Practice, Ninth Edition Audrey Berman • Shirlee Snyder Copyright © 2012 by Pearson Education, Inc. All rights reserved.
Question 2 The Pew Commission Competencies for Future Practitioners included the need for providers to become skilled in which of the following? A. Use of technology B. Emphasizing practice in tertiary settings C. Traditional clinical approaches D. Making decisions for incompetent clients Kozier & Erb’s Fundamentals of Nursing: Concepts, Process, and Practice, Ninth Edition Audrey Berman • Shirlee Snyder Copyright © 2012 by Pearson Education, Inc. All rights reserved.
Question 2 Answer A. B. C. D. Use of technology Emphasizing practice in tertiary settings Traditional clinical approaches Making decisions for incompetent clients Kozier & Erb’s Fundamentals of Nursing: Concepts, Process, and Practice, Ninth Edition Audrey Berman • Shirlee Snyder Copyright © 2012 by Pearson Education, Inc. All rights reserved.
Question 2 Rationales A. Correct. The Pew Commission identified the need for modern health care providers to be proficient in the use of technology. B. No mention is made of emphasizing practice in tertiary settings. C. The commission identified the need for contemporary (not traditional) clinical strategies. D. The commission identified the need for collaborative decision making with clients. Kozier & Erb’s Fundamentals of Nursing: Concepts, Process, and Practice, Ninth Edition Audrey Berman • Shirlee Snyder Copyright © 2012 by Pearson Education, Inc. All rights reserved.
Question 3 Which of the following is characteristic of nursing care provided in community-based health? A. Clients are primarily those with identified illnesses. B. Clients are individuals in groups according to their geographic commonalities. C. Care is paid for by the community as a whole rather than by individuals. D. All clients are case managed. Kozier & Erb’s Fundamentals of Nursing: Concepts, Process, and Practice, Ninth Edition Audrey Berman • Shirlee Snyder Copyright © 2012 by Pearson Education, Inc. All rights reserved.
Question 3 Answer A. Clients are primarily those with identified illnesses. B. Clients are individuals in groups according to their geographic commonalities. C. Care is paid for by the community as a whole rather than by individuals. D. All clients are case managed. Kozier & Erb’s Fundamentals of Nursing: Concepts, Process, and Practice, Ninth Edition Audrey Berman • Shirlee Snyder Copyright © 2012 by Pearson Education, Inc. All rights reserved.
Question 3 Rationales A. Emphasis is more on client wellness and prevention than on illness. B. Correct. In community-based health care, clients are cared for according to their geographical locations such as where they live or work, rather than at a major medical center or similar provider setting, which facilitates access. C. May be paid for through any of the usual forms of insurance or payment (including managed care, private pay, or welfare). D. Not all clients are case managed in community care. Kozier & Erb’s Fundamentals of Nursing: Concepts, Process, and Practice, Ninth Edition Audrey Berman • Shirlee Snyder Copyright © 2012 by Pearson Education, Inc. All rights reserved.
Question 4 When performing collaborative health care, the nurse must implement which of the following? A. Assume a leadership role in directing the health care team B. Rely on the expertise of other health care team members C. Be physically present for the implementation of all aspects of the care plan D. Delegate decision-making authority to each health care provider Kozier & Erb’s Fundamentals of Nursing: Concepts, Process, and Practice, Ninth Edition Audrey Berman • Shirlee Snyder Copyright © 2012 by Pearson Education, Inc. All rights reserved.
Question 4 Answer A. Assume a leadership role in directing the health care team B. Rely on the expertise of other health care team members C. Be physically present for the implementation of all aspects of the care plan D. Delegate decision-making authority to each health care provider Kozier & Erb’s Fundamentals of Nursing: Concepts, Process, and Practice, Ninth Edition Audrey Berman • Shirlee Snyder Copyright © 2012 by Pearson Education, Inc. All rights reserved.
Question 4 Rationales A. The team is generally led by the health care professional most skilled in the client’s specific areas of need. B. Correct. In collaboration, each member of the team, including the client, participates in sharing ideas and reaching consensus on the best plan of care. C. Once the plan is established, it may be implemented by any member of the team or a designate at an appropriate time and place. D. It not necessarily delegated by the nurse. Kozier & Erb’s Fundamentals of Nursing: Concepts, Process, and Practice, Ninth Edition Audrey Berman • Shirlee Snyder Copyright © 2012 by Pearson Education, Inc. All rights reserved.
Question 5 The nurse concludes that effective discharge planning (hospital to home) has been conducted when the client states which of the following? A. “As soon as I get home, the nurse will come out, look at where I live, and see what kind of care I will need. ” B. “All I need are my medications and a ride home. Then I’m all ready for discharge. ” C. “When I visit my doctor in 10 days, they will show me how to change my bandages. ” D. “I have the phone numbers of the home care nurse and therapist who will visit me at home tomorrow. ” Kozier & Erb’s Fundamentals of Nursing: Concepts, Process, and Practice, Ninth Edition Audrey Berman • Shirlee Snyder Copyright © 2012 by Pearson Education, Inc. All rights reserved.
Question 5 Answer A. “As soon as I get home, the nurse will come out, look at where I live, and see what kind of care I will need. ” B. “All I need are my medications and a ride home. Then I’m all ready for discharge. ” C. “When I visit my doctor in 10 days, they will show me how to change my bandages. ” D. “I have the phone numbers of the home care nurse and therapist who will visit me at home tomorrow. ” Kozier & Erb’s Fundamentals of Nursing: Concepts, Process, and Practice, Ninth Edition Audrey Berman • Shirlee Snyder Copyright © 2012 by Pearson Education, Inc. All rights reserved.
Question 5 Rationales A. Effective discharge planning would have included an assessment of home care needs prior to the client leaving the hospital. B. The statement does not indicate the client has the knowledge and skills to manage care after discharge. C. Following a thorough assessment, the client would be taught self-care strategies and a basic plan of care for the coming days. D. Correct. Referrals would be made by the discharge planner and communicated to the client. Option D indicates the client knows and accepts these referrals. Kozier & Erb’s Fundamentals of Nursing: Concepts, Process, and Practice, Ninth Edition Audrey Berman • Shirlee Snyder Copyright © 2012 by Pearson Education, Inc. All rights reserved.
Lecture Note Presentation Kozier & Erb’s Fundamentals of Nursing: Concepts, Process, and Practice, Ninth Edition Audrey Berman • Shirlee Snyder Copyright © 2012 by Pearson Education, Inc. All rights reserved.
Learning Outcomes 1. Discuss factors influencing health care reform. 2. Describe various community-based frameworks, including integrated health care systems, community initiatives and conditions, and case management. 3. Differentiate community health care settings from traditional settings. Kozier & Erb’s Fundamentals of Nursing: Concepts, Process, and Practice, Ninth Edition Audrey Berman • Shirlee Snyder Copyright © 2012 by Pearson Education, Inc. All rights reserved.
Learning Outcomes (cont'd) 4. Differentiate community-based nursing from traditional institution-based nursing. 5. Discuss competencies community-based nurses need for practice, including the Pew Health Professions Commission recommendations for health competencies for future health practitioners. Kozier & Erb’s Fundamentals of Nursing: Concepts, Process, and Practice, Ninth Edition Audrey Berman • Shirlee Snyder Copyright © 2012 by Pearson Education, Inc. All rights reserved.
Learning Outcomes (cont'd) 6. Explain essential aspects of collaborative health care: definitions, objectives, benefits, and the nurse’s role. 7. Describe the role of the nurse in providing continuity of care. Kozier & Erb’s Fundamentals of Nursing: Concepts, Process, and Practice, Ninth Edition Audrey Berman • Shirlee Snyder Copyright © 2012 by Pearson Education, Inc. All rights reserved.
Health Care System Changes • Factors influencing change – Health care costs – Expanding technology – Changing patterns of demographics – Shorter hospital stays – Increasing client acuity – Limited access to health care Kozier & Erb’s Fundamentals of Nursing: Concepts, Process, and Practice, Ninth Edition Audrey Berman • Shirlee Snyder Copyright © 2012 by Pearson Education, Inc. All rights reserved.
Community Nursing and Care Continuity • Trend toward an integrated, communitybased health system • Research needed to determine whethere are differences in outcome between community and institutional care • ANA’s Health System Reform Agenda – proposes balance between institutional and community-based care Kozier & Erb’s Fundamentals of Nursing: Concepts, Process, and Practice, Ninth Edition Audrey Berman • Shirlee Snyder Copyright © 2012 by Pearson Education, Inc. All rights reserved.
Influence of Nurses, Professional Organizations, and Consumers • ANA – areas for reform – Access – Quality – Cost – Workforce Kozier & Erb’s Fundamentals of Nursing: Concepts, Process, and Practice, Ninth Edition Audrey Berman • Shirlee Snyder Copyright © 2012 by Pearson Education, Inc. All rights reserved.
Influence of Nurses, Professional Organizations, and Consumers (cont’d) • Consumers – Health means well-being and quality of life, including healthy community, environment – Maintain and promote own health – Value disease prevention Kozier & Erb’s Fundamentals of Nursing: Concepts, Process, and Practice, Ninth Edition Audrey Berman • Shirlee Snyder Copyright © 2012 by Pearson Education, Inc. All rights reserved.
Influence of Nurses, Professional Organizations, and Consumers (cont’d) • The American Recovery and Reinvestment Act – Health Resources and Service Administration § Improve access to health care § Improve health outcomes and quality of health care § Eliminate health disparities § Improve the public health and health care systems § Enhance the ability of the health care system to respond to public health emergencies § Achieve excellence in management practices Kozier & Erb’s Fundamentals of Nursing: Concepts, Process, and Practice, Ninth Edition Audrey Berman • Shirlee Snyder Copyright © 2012 by Pearson Education, Inc. All rights reserved.
Primary Health Care and Primary Care • Healthy People 2000, Healthy People 2010, Healthy People 2020 – Provide a framework for national health promotion, health protection, and disease prevention • WHO and UNICEF – defined primary health care (PHC) Kozier & Erb’s Fundamentals of Nursing: Concepts, Process, and Practice, Ninth Edition Audrey Berman • Shirlee Snyder Copyright © 2012 by Pearson Education, Inc. All rights reserved.
Figure 7 -1 The interdependence of the constituents of primary care showing the centrality of the clinician-patient relationship in the context of family and community and as furthered by teams and integrated delivery systems. From Primary Care: America’s Health in a New Era (p. 34), by M. S. Donaldson, K. D. Yordy, K. N. Lohr, & N. A. Vanselow (Eds. ), 1996, Washington, DC: National Academy Press. Retrieved from http: //books. nap. edu/catalog. php? record_id 5152 Kozier & Erb’s Fundamentals of Nursing: Concepts, Process, and Practice, Ninth Edition Audrey Berman • Shirlee Snyder Copyright © 2012 by Pearson Education, Inc. All rights reserved.
Primary Health Care and Primary Care (cont'd) • Five principles of primary health care – Equitable distribution – Appropriate technology – A focus on health promotion and disease prevention – Community participation – A multisectoral approach • PHC versus primary care (PC) Kozier & Erb’s Fundamentals of Nursing: Concepts, Process, and Practice, Ninth Edition Audrey Berman • Shirlee Snyder Copyright © 2012 by Pearson Education, Inc. All rights reserved.
Table 7 -1 Differences Between Primary Care and Primary Health Care Kozier & Erb’s Fundamentals of Nursing: Concepts, Process, and Practice, Ninth Edition Audrey Berman • Shirlee Snyder Copyright © 2012 by Pearson Education, Inc. All rights reserved.
Community-based Health Care (CBHC) • Primary health care system • Services provided within context of people’s lives • Care is directed toward a specific group within the geographical neighborhood Kozier & Erb’s Fundamentals of Nursing: Concepts, Process, and Practice, Ninth Edition Audrey Berman • Shirlee Snyder Copyright © 2012 by Pearson Education, Inc. All rights reserved.
Effective CBHC System • Provides easy access to care • Is flexible in responding to care needs • Promotes care between and among health care agencies through improved communication • Provides appropriate support for family caregivers • Is affordable Kozier & Erb’s Fundamentals of Nursing: Concepts, Process, and Practice, Ninth Edition Audrey Berman • Shirlee Snyder Copyright © 2012 by Pearson Education, Inc. All rights reserved.
Community Health • Community • Functions – Production, distribution, consumption of goods – Socialization and social control – Social interparticipation and mutual support • Population • Community health nursing Kozier & Erb’s Fundamentals of Nursing: Concepts, Process, and Practice, Ninth Edition Audrey Berman • Shirlee Snyder Copyright © 2012 by Pearson Education, Inc. All rights reserved.
Figure 7 -3 The community assessment wheel, the assessment of segments of the community-as-partner model. From Community as Partner: Theory and Practice in Nursing (5 th ed. , p. 218), by E. T. Anderson and J. Mc. Farlane, 2007, Philadelphia, PA: Lippincott Williams & Wilkins. Reprinted with permission. Kozier & Erb’s Fundamentals of Nursing: Concepts, Process, and Practice, Ninth Edition Audrey Berman • Shirlee Snyder Copyright © 2012 by Pearson Education, Inc. All rights reserved.
Figure 7 -4 Model of an integrated health care delivery system. Kozier & Erb’s Fundamentals of Nursing: Concepts, Process, and Practice, Ninth Edition Audrey Berman • Shirlee Snyder Copyright © 2012 by Pearson Education, Inc. All rights reserved.
Community-Based Frameworks • Various approaches emerging to address community health including: – Integrated health care systems – Community initiatives and coalitions – Managed care – Case management – Outreach programs Kozier & Erb’s Fundamentals of Nursing: Concepts, Process, and Practice, Ninth Edition Audrey Berman • Shirlee Snyder Copyright © 2012 by Pearson Education, Inc. All rights reserved.
Figure 7 -5 Some parish-based health services provide care to community residents in addition to members of the congregation. Kozier & Erb’s Fundamentals of Nursing: Concepts, Process, and Practice, Ninth Edition Audrey Berman • Shirlee Snyder Copyright © 2012 by Pearson Education, Inc. All rights reserved.
Community-Based Settings • • • County and state health departments Schools Work places Homes Numerous additional settings Kozier & Erb’s Fundamentals of Nursing: Concepts, Process, and Practice, Ninth Edition Audrey Berman • Shirlee Snyder Copyright © 2012 by Pearson Education, Inc. All rights reserved.
Recent Community Health Settings • Community nursing centers (nurse managed) • Parish nursing • Corrections nursing • Telehealth projects Kozier & Erb’s Fundamentals of Nursing: Concepts, Process, and Practice, Ninth Edition Audrey Berman • Shirlee Snyder Copyright © 2012 by Pearson Education, Inc. All rights reserved.
Community-Based Nursing (CBN) • Care directed toward specific individuals • Extends beyond institutional boundaries • Involves a network of nursing services Kozier & Erb’s Fundamentals of Nursing: Concepts, Process, and Practice, Ninth Edition Audrey Berman • Shirlee Snyder Copyright © 2012 by Pearson Education, Inc. All rights reserved.
CBN Network • • • Nursing wellness centers Ambulatory care Acute care Long-term care nursing services Telephone advice Kozier & Erb’s Fundamentals of Nursing: Concepts, Process, and Practice, Ninth Edition Audrey Berman • Shirlee Snyder Copyright © 2012 by Pearson Education, Inc. All rights reserved.
CBN Network (cont’d) • Home health • School health • Hospice services Kozier & Erb’s Fundamentals of Nursing: Concepts, Process, and Practice, Ninth Edition Audrey Berman • Shirlee Snyder Copyright © 2012 by Pearson Education, Inc. All rights reserved.
Achieving Pew Competencies • Nurses need the following knowledge and skills: – Primary care – Preventive care – Population-based care – Health care access – Community partnerships – Interdisciplinary teams – Public policy Kozier & Erb’s Fundamentals of Nursing: Concepts, Process, and Practice, Ninth Edition Audrey Berman • Shirlee Snyder Copyright © 2012 by Pearson Education, Inc. All rights reserved.
Box 7 -6 Pew Commission Competencies for Future Practitioners Kozier & Erb’s Fundamentals of Nursing: Concepts, Process, and Practice, Ninth Edition Audrey Berman • Shirlee Snyder Copyright © 2012 by Pearson Education, Inc. All rights reserved.
Collaborative Health Care • Collaboration - ANA’s Definition of Collaborative Health Care – “Collegial working relationship with another health care provider in the provision of patient care. ” – Objective is to provide optimal health care to the client Kozier & Erb’s Fundamentals of Nursing: Concepts, Process, and Practice, Ninth Edition Audrey Berman • Shirlee Snyder Copyright © 2012 by Pearson Education, Inc. All rights reserved.
The Nurse Collaborator • With nurse colleagues • With other health care professionals • With nursing professional nursing organizations • With legislators Kozier & Erb’s Fundamentals of Nursing: Concepts, Process, and Practice, Ninth Edition Audrey Berman • Shirlee Snyder Copyright © 2012 by Pearson Education, Inc. All rights reserved.
Key Elements Necessary for Collaboration • • Effective communication skills Mutual respect Trust Decision-making process Kozier & Erb’s Fundamentals of Nursing: Concepts, Process, and Practice, Ninth Edition Audrey Berman • Shirlee Snyder Copyright © 2012 by Pearson Education, Inc. All rights reserved.
Continuity of Care • Coordination of health care services, including – Initiation of discharge planning on admission – Involvement of the client and support persons – Collaboration with other health care professionals – Care across the life span Kozier & Erb’s Fundamentals of Nursing: Concepts, Process, and Practice, Ninth Edition Audrey Berman • Shirlee Snyder Copyright © 2012 by Pearson Education, Inc. All rights reserved.
Discharge Planning • Process of preparing a client to leave one level of care for another • Assessment – Comprehensive information about client’s ongoing needs; begins on admission – Health care team conferences § Focus on ways to individualize care for client Kozier & Erb’s Fundamentals of Nursing: Concepts, Process, and Practice, Ninth Edition Audrey Berman • Shirlee Snyder Copyright © 2012 by Pearson Education, Inc. All rights reserved.
Discharge Planning (cont’d) • Assessment (cont’d) – Family conferences § Health professionals and family discuss issues related to client Kozier & Erb’s Fundamentals of Nursing: Concepts, Process, and Practice, Ninth Edition Audrey Berman • Shirlee Snyder Copyright © 2012 by Pearson Education, Inc. All rights reserved.
Box 7 -8 Discharge Planning: Home Assessment Parameters Kozier & Erb’s Fundamentals of Nursing: Concepts, Process, and Practice, Ninth Edition Audrey Berman • Shirlee Snyder Copyright © 2012 by Pearson Education, Inc. All rights reserved.
Health Care Teaching for Discharge to Home • Essential information – Medications – Dietary and activity restrictions – Signs of complications to report to primary care provider – Follow-up appointments and telephone numbers – Where supplies can be obtained – Safe performance of necessary treatments Kozier & Erb’s Fundamentals of Nursing: Concepts, Process, and Practice, Ninth Edition Audrey Berman • Shirlee Snyder Copyright © 2012 by Pearson Education, Inc. All rights reserved.
Clients Who Frequently Require Referrals Older adults Children with complex conditions Frail persons who live alone Those without support or with limited support • Those with a caregiver whose health is failing • Those in homes with barriers to safety • • Kozier & Erb’s Fundamentals of Nursing: Concepts, Process, and Practice, Ninth Edition Audrey Berman • Shirlee Snyder Copyright © 2012 by Pearson Education, Inc. All rights reserved.
- Slides: 54