JUDITH M. WILKINSON LESLIE S. TREAS KAREN BARNETT MABLE H. SMITH FUNDAMENTALS OF NURSING Copyright © 2016 F.A. Davis Company Chapter 43: Community & Home Health Nursing

Copyright © 2016 F.A. Davis Company What Is a Community? “Fellowship of common feelings” A group of like-minded people A group that works together People who share a common language, rituals, and customs

Copyright © 2016 F.A. Davis Company Components of a Community Structure – Demographic data: age, gender, ethnicity Status – Biological data – Emotional data – Social data Process – Overall effectiveness

Copyright © 2016 F.A. Davis Company Vulnerable Populations Have increased risk for adverse health outcomes Factors contributing to vulnerability – Limited economic and social resources – Age – Presence of chronic disease – History of abuse/trauma

Copyright © 2016 F.A. Davis Company Community-Based Care Three approaches Community health nursing Public health nursing Community-oriented nursing

Copyright © 2016 F.A. Davis Company Community Health Nursing Focus: how individual health affects the community Goal: maintain health of the population Deliver personal health services

Copyright © 2016 F.A. Davis Company Public Health Nursing Focus: effect of community’s health on individual Goal – Prevent disease – Promote health for individuals, families, and groups – Protect health of the community

Copyright © 2016 F.A. Davis Company Community-Oriented Nursing Combines community and public health More comprehensive approach Uses information from individuals to change health on the community level

Copyright © 2016 F.A. Davis Company Pioneers of Community Nursing Florence Nightingale Lillian Wald Clara Barton Margaret Sanger

Copyright © 2016 F.A. Davis Company Roles of Community Nurses Client advocate Educator Collaborator Counselor Case manager

Copyright © 2016 F.A. Davis Company Community Nursing Interventions Primary: promote health/prevent disease – Education of “at risk” clients Secondary: reduce disease impact; early detection and treatment – Health screening Tertiary: halt disease progression/ restore health – Treatment

Copyright © 2016 F.A. Davis Company Community-Based Nursing Practice School nursing Occupational health Parish nursing Correctional nursing Public health Disaster services International nursing

Copyright © 2016 F.A. Davis Company Geopolitical Community Assessment Windshield survey Database utilization Client perceptions

Copyright © 2016 F.A. Davis Company Who Receives Home Healthcare? Those with skilled-care needs (e.g., older adults) Those recuperating from illness/surgery Those who are terminally ill Those with chronic illnesses; to avoid hospitalization

Copyright © 2016 F.A. Davis Company Goal of Home Healthcare Promoting self-care by – Fostering client independence – Completing client/family teaching – Demonstrating skill techniques – Explaining all aspects of care

Copyright © 2016 F.A. Davis Company Advantages and Disadvantages of Home Care Advantages – Enables viewing of client’s environment – Allows inclusion of family members in care – Increases autonomy of nursing practice – Teaches flexibility – Facilitates holistic care Disadvantages – Uncontrolled environment – No readily available supplies – Lack of immediate peer assistance – Potential for personal safety issues

Copyright © 2016 F.A. Davis Company Home Healthcare Agencies Direct care agencies Indirect service agencies Types – Public – Voluntary – Proprietary – Hospital based

Copyright © 2016 F.A. Davis Company Roles of the Home Health Nurse Direct care provider – Performing tasks that require skill Client/family educator – Promoting self-care – Communication skills needed Client advocate – Supporting client’s right to make decisions Care coordinator – Developing plan of care – Accessing the correct resources

Copyright © 2016 F.A. Davis Company Reimbursement Issues Medicare – Designed for those >65, disabled, and ESRD – Specific criteria must be met Medicaid – For those with limited financial resources Private insurance company Nurse’s role – Be aware of necessary criteria, services covered, documentation needed

Copyright © 2016 F.A. Davis Company Conducting a Home Care Visit Before the visit – Determine purpose of visit. – Gather necessary supplies/materials. – Be aware of additional information needed. – Make an appointment with the client. – Assess the area for safety considerations.

Copyright © 2016 F.A. Davis Company Conducting a Home Care Visit (cont’d) During the visit – Make introductions. – Be respectful of client’s home, beliefs,practices, cultural differences. – Develop a trusting relationship. – Verify/complete data. – Identify barriers to accomplishing goals of visit.

Copyright © 2016 F.A. Davis Company Conducting a Home Care Visit (cont’d) After the visit – Maintain safety precautions. – Proceed to safe area to check directions. – Complete necessary documentation.

Copyright © 2016 F.A. Davis Company Think Like a Nurse Refer to the Meet Your Patients scenario in the textbook. What, if any, evidence of caregiver strain does Mrs. Escobar exhibit?