Community – Based
Nursing
Lisa B. Flatt, RN, MSN,
CHPN
Community Setting
 Outside
of the hospital or clinics
 Typically in the home
Concepts
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Community – social group (any size)
– Located in same area
– Shared government
– Common goals: social, religious, occupations, at-risk
population
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Community-based health care- care in daily lives,
holistic
– Easy access
– Flexible & supportive
– Continuity of care in home and facility settings
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Home care – visiting nurse
– Easy access
– Flexible & supportive
– Continuity of care in home and facility settings
Community Functions
 Production
 Distribution
 Consumption
of goods
 Socialization
 Social
control
 Social interparticipation
 Mutual support
Healthy Community (Kozier, et al
2000)
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Group togetherness
Conserve natural resources
Subgroups, community participation
Crises preparation
Community problem solving
Open channels of communication
Community problem solving
Available resources
Dispute resolution
Group decision making
Wellness amongst members
Nurse’s Roles
Community-based – primary health care
provider, not confined to community roles
 Case manager – variety of nursing duties
 Collaborator – other disciplines
 Discharge planner – prepare for another
level of care
 Community health nurse – prevention, ie
flu, epidemics, toxic exposure
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Health Promotion
Primary prevention – ie. Condoms avoid
_STD, kids_, eliminates risks that can be
modified, another one is _vaccines
prevent diseases, and diarrhea__
 Secondary prevention – health screening _mammogram-breast cancer, Pap smear,
HPV, education__, detects presence of
predisposing factors
 Tertiary prevention – treatment and rehab
after a disease, __chemo, laser, radiation,
abx___
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Horton hears a WHO
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Who is WHO: World Health Organization
What do they do: help the disadvantaged, 3rd world
countries
HFA is Health For All
– Health policies – travel and illness, flu shots
– Social and economic development – bird flu, caging,
awareness, s/s, education
– Provision of health care – txment (isolated)
– Health status – wellness, prevention
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World Bank- $ allocation for basic needs, wells, water,
shelter
Pan American Health Organization – Latin American,
education, research and environment
American Red Cross – Clara Barton, RN – community health
nurse ER preparedness, blood drives
We Got Here
CDC – Centers 4 disease control and
prevention - education and statistics
 FDA – Federal Drug Administration –
regulation and legal implications
 DHHS-Dep’t Health and Human Services
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– Soc Sec
– HCFA Health care financing administration
– Administration for kids and families – food
stamps, WIC
– Public Health Services – Medicare home care
benefits
Medicare
Elderly (old farts)
 1988 – everyone over 65 y/o, disabled
and dependents
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– Part A – hospitalization and home care,
hospice
– Part B – voluntary, dr. coverage, therapy under
certain circumstances
– All pay deductible and co-pay
– No dental, no preventive stuff, no routine
physical, no routine tests
Medicaid
 Federal
public assistance
 Low income
 Medicare and medicaid – elderly low
income, needs med’s
 Transplants, hemodialysis
DHHS: Health People 2010
National Health Promotion and
Disease Prevention Objectives
 Increase
lifespan
 Reduce health disparities, all
Americans access to care
 Decrease race-disparity in life
expectancy – Black Americans,
increased HTN, kidney disease, CVA
State Health Departments
All different
 Rules and regulations
 Health codes
 Licensing
 Manage own programs
 Kids and MRDD
 Local Health Dept’s
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– Small clinics, etc… flu shots, kid shots, BCP,
condoms (?)
Three Levels of Community Health
Care
 Illness
– sickie
 Illness/disease prevention – shots,
needle exchanges
 Health promotion – education
schools, community fairs
Epidemiology
Study of dx prevention
 Occurrence, incidence, causes
(OUTBREAK)
 Infectious diseases
 Epidemic – outbreaks of diseases, region
 Pandemic – across countries (HIV)
 Primary – promotion, prevention
 Secondary – acute care, emergency care,
dx and treatment
 Tertiary – long term care, dying,
rehabilitation
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Terms
 Frequency,
incidence and prevalence
– how often, when, where
 Morbidity and mortality – death
– Morbidity - # sick
– Mortality - # died
– Communicable diseases – diseases you
catch, infectious, direct or indirect,
airborne, droplet, contact
Kids, etc…
 Infants
and young kids –
immunizations, prevention and
education
 Toddlers- eat weird things – paint
– Chelation therapy(bld levels over 44, 70
ER) – metallic ion IV txment (Iron)
– School-age kids – MVA’s, peer pressure,
smoking, etc…
Kids, etc..
 Adolescent
– preggers, peer
pressure, eating disorders
 Young adults – STD’s, weight control,
smoking and ETOH
 Middle aged – HTN
 Older Adult – abuse
 Developmental disabilities community based care
Family Issues
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Violence – increase need for health care
Dysfunction
Divorce
Disrupted – foster care, military
Ineffective parenting skills – immature, mental illness, physical ill
Educational levels –
Socioeconomic status – immigration, illegal or legal, poverty and access to care
Lifestyle, health habits – eating McD’s
Physical conditions – coach roaches in homes =asthma
Family nutrition risks – food stamps, hoarders
Maternal child health – cornerstone of health
Substance abuse – poor nutrition, sell for drugs
Cultural/spiritual/religious beliefs
Community beliefs
Health expectations
Environmental – homeless, ER plans, waste disposal, sanitation
Psychological – PTSD, depression, anxiety
Ethnic caregivers/community based – midwives, shamans, etc….
Nursing Process
 Pg
158-160