COMMUNITY HEALTH
ROXANNE RIEDY MSN
MARILEE ELIAS MSN, CNE
Community
• “the gift or fellowship of common
relations and feelings”(Hiemstra, 2000)
• It’s a group:
– of like-minded people
– that works together
– who share a common language, rituals,
and customs
Population
• All the individuals inhabiting a
specific area
• Leesburg, FL 22,286 (2009)
• Clermont, FL 13,252 (2009)
(www.census.gov )
Aggregate
• A group of individuals with at least
one shared characteristic (personal
or environmental)
• We each belong many aggregates.
What are some of yours?
Community Components
• Structure
• Status
• Process
Community Components
Structure: general characteristics of a
community, includes:
– Demographic data
– Data about healthcare services
Community Components
Status: describes the outcome components
of the community
– Biological Outcome Components
– Emotional Outcome Components
– Social Outcome Components
Community Components
• Process: the overall effectiveness of
the community
– Perceptions of group membership
– Extent of intergroup interactions
– Community forum for conflict resolution
What makes a Community
Healthy?
Healthy People Initiatives
• We’re in the 4th decade of this national
health framework for public health
preventions priorities and actions.
• The overarching goals and focus topic
areas are refocused every 10 years using
the input from public health and
prevention experts, government officials
and the public.
Healthy People 2020
• “The launch of Healthy People comes at a
critical time. Our challenge and
opportunity is to avoid preventable
diseases from occurring in the first place.”
HHS Secretary Katherine Sebelius
• Use of IT to make Healthy People come
alive through a “challenge” to develop
‘myHealthyPeople’ apps. (www.healthypeople.gov )
• Revision of Healthy People 2010
Healthy People 2020
• 13 New Topic Areas
• Main (or broad) goals of this plan:
– increase healthy life expectancy
– reduce health care disparities
– create social and physical environments that
promote good health for all
– Promote quality of life, healthy development,
and healthy behaviors across all life stages
New Topic Areas 2020
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Adolescent Health
Genomics
Blood Disorders & Blood Safety
Global Health
Early and Middle Childhood
Preparedness
Dementias, including Alzheimer’s Disease
Healthcare-Associated Infections
Health-Related Quality of Life and Well-Being
Lesbian, Gay, Bisexual, and Transgender Health
Sleep Health
Social Determinants of Health
What’s in Healthy People 2020?
(www.healthypeople.gov)
Each Community also has
Vulnerable Populations
• Aggregate with increase risks for:
– Developing illness
– Adverse health outcomes
Vulnerable Populations
Vulnerability Factors:
– Limited economic resources
– Limited social resources
– Age
– Chronic disease
– History of abuse or trauma
Federal Poverty Levels
• Issued each January
– Range of 25% to 300% of Poverty Level
– Based on Family Size
– Pregnant woman= family of 2
• Low-income assistance programs base
benefits on these official income levels
Community Nursing
• A Community is:
–A site for Healthcare Delivery
–A recipient of Healthcare Services
Community Based Care
• Focuses on the community
• Focuses on lowering the cost of care
• Healthcare Services are provided in
many types of Facilities
• Acute care
• Rehabilitative services
Community Based Care
Three approaches
• Community health nursing
• Public health nursing
• Community oriented nursing
Community Based Care
Community Health Nurse
• Focus: how the Individual’s Health
affects the health of the community
• Goal: maintain health of the
population
• Deliver personal health services
Community Based Care
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Public Health Nursing
Focus: effect of Community’s
Health on individual
Goal: prevention of disease; promote
health
Protect health of the community
Large-scale programs
Community Based Care
Community-Oriented Nursing
• Combines community and public
health
• More comprehensive approach
• Uses information from individuals to
change health on the community
level
Pioneers of Community
Nursing
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Florence Nightingale
Lillian Wald
Clara Barton
Margaret Sanger
Community Nursing
• Empowering the Individual and the
Community:
– Access and Use Available Resources
– Achieve/Maintain Desired Level of Health
– Achieve Autonomy
– Maintain Positive Self-esteem
Roles of Community
Health Nurse
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Client advocate
Educator
Collaborator
Counselor
Case Manager
Community Nursing
Intervention
Classification
• Primary
(first-level)
• Secondary (second-level)
• Tertiary
(third-level)
Community Based
Careers
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School nurse
Occupational health
Parish nursing
Correctional nursing
Public health
Disaster services
International
Geopolitical Community
Assessment
• Windshield survey
• Databases
• Client perceptions
Nursing Diagnosis
• Analyze the information, develop a
list of the communities strengths and
limitations
• Prioritize the information
• Create a community based diagnosis
Nursing in Home Care
Home Health
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Established in 1800’s
Growth R/T Medicare Payments (1965)
Over 132,000 RNs delivering care
Over 1,000,000 Work in Home Care
Over 12 million patients
2009 projected costs over $72 billion
( www.nahc.org, 2012)
Home Health Care
Recipients
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Individuals with skilled-care needs
Recuperating from illness or surgery
Terminal ill
On going care for individuals with
chronic illnesses in an attempt to
prevent hospitalization
How do our clients get
referred to home
healthcare?
• Hospital-based Referrals
• Other Community Sources of Referrals
• Reimbursement Evaluation
Goal of Home Health care
• Promoting self-care by:
– Fostering client independence
– Completing client/family teaching
– Demonstrating skill techniques
– Explaining all aspects of care
Home Health Care
• Advantages
• Disadvantages
Home Health Agencies
• Direct care agencies
• Indirect service agencies
• Types of agencies
Public
Voluntary
Proprietary
Hospital-based
Home Health Team
• RN is coordinator of health services
• Multidisciplinary Team based on
patients needs
Roles of Home Health
Nurse
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Direct care provider
Client /family educator
Client advocate
Care Coordinator
Hospice Nurse
• Focus is caring for pt’s who are dying
or condition is not expected to
improve
• Care can be provided in the hospital,
home, nursing home or Hospice
house
• Promote comfort & quality of life
Reimbursement
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Medicare
Medicaid
Private insurance company
Patient Self-Pay
Medicare
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Individuals over 65 or
Disabled or
Diagnosis of ESRD
Largest payer- over $15 billion (2007)
Employer- over 90,000 RNs
Criteria-based Reimbursements
Medicaid
• Individuals with limited financial
resources
• Sponsored by federal government
and each state
• Payer for Home and Hospice Care
Private Insurance
• Sources:
– Employer
– Retirement Plan Benefit
– AARP and other available plans
• Criteria-based Reimbursements
(again)
• Documentation is Vital for Payment
Future of Home Health
Care
• Expect Increased Use
• Increased home Hospice care
• Technological advances = safe and
affordable complex care in the home
• Expanded research
Home Visit
Three phases
• Preparation prior to the visit
• Nursing care provided during the visit
• Evaluation after the visit is completed
Home Visit
Before the visit:
– Review Chart/Referral Form
– Gather necessary Supplies/Materials
– Assess need for additional information
– Schedule Home Appointment
– Assess Safety Issues
Home Visit
During the visit:
– Make introductions
– Initial Visit is vital to building trust/rapport
– Be respectful of client’s home, beliefs,
practices, cultural differences
– Develop a trusting relationship
– Verify/complete data
– Identify barriers to goals
– Begin Documentation
The Home Visit Review
• We’re Nurses so we:
– Assess
• Client
• Home Safety Issues
• Infection Control Issues
– Generate Nursing Diagnoses
• Risk for Caregiver Role Strain
• Caregiver Role Strain
– Plan Outcomes/Evaluations
– Plan Interventions/Implementation
Home Visit
After the visit:
– Safety (again)
– Proceed to safe area PRN & then
– Complete necessary documentation