1 Chapter 2. Community-Based care Key TERMS Learning OBJECTIVES. community After studying the chapter content, the student should be able to Community-Based nursing accomplish the following: complementary and alternative medicine 1. Define the key terms. cultural competence 2. Differentiate Community-Based nursing practice from acute care settings. cultural encounter 3. Describe nursing roles in Community-Based health care . cultural self-awareness 4. Explain the difference between primary, secondary, and tertiary health care and cultural skill give an example of how each may be provided in the community . epidemiology 5. Identify at least three barriers to cultural competence. home visits 6. Outline strategies for integrating elements of alternative/complementary outpatient clinics therapies and scientific health care practice.
2 Primary prevention secondary prevention telephone consultation services tertiary prevention wow To recognize diversity in others and respect it, we must first have some awareness of who we are. N ursing in the United States began as Community-Based nursing. Self-trained Concepts of community women cared for the sick and dying, assisted women in Because Community-Based nursing care is part of the con- laboring and birthing, and provided health education to tinuum of health care services, it is important for nurses to those without access to it. Community-Based nursing is understand the concepts of community . Often community the application of the nursing process in caring for indi- is defined as a collection of people sharing common char- viduals and families in community settings. The focus of acteristics, interests, needs, resources, and environments Community-Based nursing is illness-oriented care of indi- that interact with one another.
3 The common features of a viduals and families throughout their life cycle. Its goal is community may be common rights and privileges as mem- to help people manage acute or chronic health conditions bers of a designated city or common ties of identity, val- in community and home settings. It emphasizes all levels ues, norms, culture, language, or social support. Women of prevention ( , primary, secondary, and tertiary), but are caregivers to children, parents, spouses, and neighbors, focuses more on secondary and tertiary levels. Secondary and provide important social support in these roles. A per- health care typically refers to relatively serious or compli- son can be a part of many communities during the course cated care that has historically been provided in the acute of daily life. Examples would be area of residence (home, care setting.)
4 Examples of Community-Based secondary care apartment, shelter), gender, place of employment (organi- include outpatient surgery for complex procedures that zation or home), language spoken (Spanish, Chinese, would have been previously done in the hospital setting English), educational background or college student sta- (cholecystectomy, hysterectomy, appendectomy), chemo- tus, culture (Italian, African-American, Indian), career therapy, radiotherapy, magnetic resonance imaging (MRI), (nurse, business woman, housewife), place of worship and angiography. Tertiary health care encompasses the (church or synagogue), and community memberships management of chronic, complicated, long-term health (Women's Garden Club, YMCA, Women's Support problems that is now delivered in the community setting. Group, school PTA).
5 In Community-Based nursing, the Centers for cardiac rehabilitation, home health care for community is the unit of service. In Community-Based set- bed-bound elderly people, home care for respiratory- tings, the providers of care are concerned not only with the dependent people, and hospice care for the terminally ill are clients who present themselves for service, but also with a few examples of tertiary health care community settings. the larger population of potential or at-risk clients. Preventive health care serves people of all ages and at all levels of health . Improving access to health care means bringing health services that support a continuum of care Community-Based Nursing to people where they live. The health needs of society and consumer demand Nurses are essential in each of these community - brought about Community-Based and community -focused based settings and for each level of care described.
6 Nursing services. The movement from an illness-oriented cure . practice in the community is similar to that within the perspective in hospitals to a focus on health promotion and acute care setting because assessing, performing proce- primary health care in Community-Based settings has dra- dures, administering medications, coordinating care matically changed employment opportunities for today's services and equipment, counseling patients and their nurses. This shift to emphasizing primary care , and out- families, and teaching clients and their families regard- patient treatment and management will very likely con- ing their care are all part of the care administered by tinue. As a result, employment growth in a variety of nurses in the community . Community-Based settings can be expected for properly During the past several years, the health care deliv- trained nurses.
7 Ery system has changed dramatically. The health care The 2000 National Sample Survey of Registered business is focused on controlling costs, sometimes at Nurses (USDHHS/DON 2001) found the following the expense of patient care . To control costs, people are trends in registered nurse (RN) employment settings: spending less time in the hospital. Patients are being dis- charged sicker and quicker from their hospital beds. The percent of RNs working outside the hospital setting The health care system has moved from reactive treat- is ment strategies in hospitals to a proactive approach in RNs employed in Community-Based settings showed a the community . This has resulted in an increasing empha- 36% increase between 1992 and 2000, which was largely sis on health promotion and illness prevention within the result of an increase in nurses working in home health the community .
8 care and managed care organizations. 22. Chapter 2 Community-Based care 23. Community-Based settings include ambulatory care , Nurses in the Community-Based arena are well positioned home health care , occupational health , school health , and to be the primary force in identifying the challenges and hospice settings (Table 2-1). Clinical practice within the implementing changes in women's health for the future. community may also include case management, research, quality improvement, and discharge planning. Nurses with Community-Based Nursing Roles advanced practice and experience may be employed in Many nurses find the shift from acute care to community areas of staff development, program development, and settings a challenge. However, nurses working in com- community education. Nurses must be educationally and experientially pre- munity- based settings share many of the same roles and pared to provide care in very diverse settings.
9 The goals responsibilities as their colleagues in acute care settings. of Healthy People 2010 to increase quality and years of For example, nursing assessment and interventions are healthy life and to eliminate health disparities are attainable practiced in a variety of community settings. As nurses build their experiences in Community-Based settings, they through Community-Based health care activities and inter- will also develop their roles in case management, patient ventions. The focus of health initiatives today shifts the emphasis of health care to the people themselves and their education, collaborative practice, counseling, research, needs, reinforcing and strengthening their capacity to shape and advocacy for individuals and families. See Table 2-2. their own lives. This shift of emphasis away from depen- for examples of these roles.
10 The nurse who implements dence on health professionals toward personal involvement these roles in the community demonstrates a caring and and patient responsibility gives nurses the opportunity to comprehensive client-centered nursing practice. interact with individuals in a variety of self-help roles. Community-Based Nursing Interventions Table 2-1 Community-Based Practice Settings Nursing interventions involve any treatment that the nurse performs to enhance the client's outcome. Although cer- Setting Description tain nursing interventions are universal in most settings, Ambulatory care Doctor's offices the ones described in Box 2-1 are particularly prevalent in settings health maintenance Community-Based practice. organizations (HMOs). Day surgery centers Community-Based Nursing Challenges Freestanding urgent care centers Despite the positive benefits achieved by caring for fami- Family planning clinics lies within their own home environments and community , Mobile mammography challenges also exist.