Community Health Nursing Roles. Karen L. Gunn. Ferris State University

Transcription

1 Running head: COMMUNITY HEALTH NURSING ROLES Community Health Nursing Roles Karen L. Gunn Ferris State University

2 COMMUNITY HEALTH NURSING ROLES 2 Abstract This paper describes community-based nursing care using individuals, communities and aggregates as their clients. It describes the roles and responsibilities and the educational preparation of the community health nurse. It compares and contrasts the two types of clients, using typical settings and sources of funding for services.

3 COMMUNITY HEALTH NURSING ROLES 3 Public health nursing or community health nursing has different client bases from which to choose. They can choose to work with individual clients or a community or aggregates in order to deliver care. Community health nursing has a varied history. It has evolved from the visiting nursing and the district nursing from both the United States and Europe. Visiting nurses were nontrained laypersons who provided care for the ill in their own homes. They were usually people of a religious order in Europe and nonreligious organizations in the United States, such as benevolent and ethical societies (Maurer and Smith, 2009, pg 32). District nursing started in England following a suggestion to Florence Nightingale. It was proposed that the nurses work within a district or parish in a given area. In the United States, Lillian Ward included these factors in her concept of public health nursing (Maurer and Smith, 2009, pg 32). As times have changed, so has the educational background required for public health nursing. Public health nurses should have a background in epidemiology, statistics and research, have an orientation to health care systems, be able to identify high risk populations, know the needed interventions, apply public health concepts of cares of culturally diverse populations, and have orientation to regulations affecting public health nursing practice (Maurer and Smith, 2009, pg 3). They are baccalaureate-prepared and are responsible for identification of needs, advocate and make necessary referrals, teach health promotion and prevention, screen and do case finding, environmental management, collaboration and coordination, and political action (Maurer and

4 COMMUNITY HEALTH NURSING ROLES 4 Smith, 2009, pg 15). Future needs will include specialization such as preparation for nurse practitioners, clinical specialists, and community health specialists. Individuals as Clients About two thirds of the people receive long-term care in the community; the remaining one third living a care facility or institutional setting. Most of those living in the community live in a family setting but many do live alone without family support. There are many resources available to those individuals (Health in Aging,Aging in the Know, 2009). The community health nurse is a member of an active team of caregivers involved in trying to keep people in their home setting. The others include primary care physicians, nurse practitioners, physician s assistants, respiratory, occupational and physical therapists and nursing assistants. The community health nurse is one of the members who interview, develop a plan of care, initiate referrals, and evaluate the care plan to check effectiveness. Many of these clients are home nearly all the time. They are out of the home for only a short period of time and much effort is required on the patient s part or that of a care giver to get them to medical appointments or for treatment. These types of patients include those with impaired mobility or the morbidly obese. The community health nurse is able to evaluate these patients to determine what cares are needed and when they should be delivered. They are also able to offer support to the care givers who can become stressed or over-whelmed by the needed care. Community health nurses are able to access the patient and how they can function in their own home. They can determine whether the patient is able to do his own activities of daily

5 COMMUNITY HEALTH NURSING ROLES 5 living, such as dressing or bathing. It can also be determined if their care giver s abilities are adequate for meeting the patient s needs. Support, training and education can be identified (Aging in the Know, 2009). Home evaluations are also a way to evaluate any environmental modifications that may be needed. The need for hand rails, shower and bath aids, proper commode facilities, and grab bars is evaluated. Barriers are also noted, including narrow halls and doorways and stairs. Lift devices and outdoor ramps may be needed. Evaluations for technical devices may be necessary. Use of Life Line or a like product may be recommended. Speaker phones may be a benefit. Other options for socialization may be delivered. Adult day care facilities and day hospitals are an option. They may be staffed with registered nurses to certified aides to provide needed levels of care. These facilities are also a way of providing care while primary caregivers are at work or as respite for caregivers. Evaluations may also include the recommendation to have the patient leave the home setting for a change of residence (Aging in the Know 2009). This may be an assisted living facility, group home or continuing-care retirement communities. These retirement communities have a variety of care levels and range from independent living to skilled nursing home care, usually in the same facility. As the client s health care needs change, the level of care changes as well. Besides the elderly, infants, children and young adults also make up the individual client base. Collaboration between public health and personal health services providers is essential to

6 COMMUNITY HEALTH NURSING ROLES 6 assure adequate immunizations, prevent childhood injuries, ensure adolescents access to responsive preventative care, and provide a full range of specialty and comprehensive services to children with chronic illnesses and their families (Perrin, Guyer and Lawrence, 1992). The roles and responsibilities include identifying and monitoring child and adolescent health needs and services, setting and enforcing standards of care, developing community health education programs, preventing and eliminating environmental hazards and provide training for direct services (Perrin et al, 1992). It has been found that nurses are likely to be the most effective, especially when dealing with pregnant women, infants, and young children, because they can answer the healthrelated questions that most new mothers have about themselves and their children (Gomby, Larson, Lewit, and Behrman, 1993) than lay persons. Nurses are also better able to engineer successful contacts with the health care system than home visitors with other backgrounds (Gomby et al, 1993). Community or Aggregate Clients Community health nursing can be involved with larger numbers of patients as their clients. This could be a family or a community. Community health nurses seek to promote health; prevent specific illness, injuries, and premature death, and reduce human suffering (Maurer and Smith, 2009, pg 302). This involves the few to the many. While working with families, the nurse can determine issues during a home visit that are not noted during a doctor s office call. This includes the general state of the home, safety issues, and interaction between the family members. The level of adjustment of the family members to

7 COMMUNITY HEALTH NURSING ROLES 7 the chronically ill is noted as well as taking on the tasks that were previously done by the ill member. The nurse attempts to identify actual and potential problems within the family. Nursing efforts are not always successful. But, by showing concern, home visits will be beneficial to the family. The nurse s presence means related interpersonally in ways that reveal positive regard, empathy, genuineness, and caring concern (Maurer and Smith, 2009, pg 309). Community health nurses also work with larger numbers of people. Community is defined as an open social system that is characterized by people in a place who have common goals over time (Maurer and Smith, 2009, pg 397). This can be a religious community, or somewhere with definite boundaries, such as a neighborhood or city. The assessment includes the boundaries or parameters of the community. This may be spatial and concrete, natural or man-made, or by census tract. In any instance, the work involves knowing or finding out what is needed for the betterment of the greatest number of the community. After the assessment is complete, and a problem identified, the next step is to determine the target population. Who would benefit from this change? The change could be targeting an aggregate, defined as any number of individuals with at least one common characteristic (Maurer and Smith, 2009, pg 397) or the community as a whole. A planning group is formed who is concerned with the health problem; find who can contribute resources to the plan, and who would follow through with the plan of action. A goal is established and possible solutions discussed and evaluation is done. There are several types of interventions that can be utilized in the community. Included are health-education programs, screening programs, establishing services, policy setting and

8 COMMUNITY HEALTH NURSING ROLES 8 implementation, increasing self-help and competence, and increasing power among disenfranchised individuals (Maurer and Smith, 2009, pg 445). Health programs provide information on how to promote health, manage illness, manage care for those who are ill, minimize the effects of illness and injury and ensure a healthful environment (Maurer and Smith, 2009, pg 445). Screening programs include blood pressure clinics and improving access to treatment for diseases. Establishing services means school health clinics, grocery shopping services and formation of adult day care centers. Community health nurses may initiate the need for a change in legislation on the local or state levels if that is what is required and may be involved in the lobby process to get these needs met. Sources for Funding Funding sources vary from self pay, to private insurance and governmental support. Some of the day care activities are private pay as well as some home visits. One challenge is identifying who is in charge of the patient in the home setting. Proper documentation is important to obtain the proper reimbursement for these cares (AMDA Online Education, 2009). Changes in Medicare have increased payments for home visits. This allows home care to be more affordable and allow shorter acute care stays (Aging in the Know, 2009). Justification is needed as there are no specific restrictions in the number of home visits. It is suggested that a minimum of four home visits is necessary before change in health or developmental domains can occur at all and that regular and fairly frequent visits over at least a few years are necessary before meaningful change occur (Gomby et al, 1993).

9 COMMUNITY HEALTH NURSING ROLES 9 Government funding has been cut in the present budget crisis situation. The federal government had decreased the amount allotted to the states in hopes that the state would assume the majority of funding. The states, in turn, have cut budgets to the local level, reducing staff and needed equipment to maintain programs. Many of these cuts affect the low income, vulnerable populations. Welfare reform has cut needed programs aimed at low income families. Limitations on how long they remain of welfare are decreased. Food stamp programs and WIC (Women, Infants and Children) benefits are decreased. Welfare reform for immigrants had benefits severely cut. They are no longer eligible for benefits from SSI, Medicaid, TANF (Temporary Assistance to Needy Families), or state block grants. Medicaid is provided only as an emergency measure (Maurer and Smith, 2009, pg 546), such as labor and delivery being a covered benefit but prenatal care is not. Undocumented or illegal immigrants are barred for all federal public benefits (Maurer and Smith, 2009, pg 546). Some of the families who have moved off welfare have improved their economic status. Those who haven t done so still have low paying jobs that are below the poverty level and have no benefits. Some, because of the time limitations, receive no assistance at all. Some of the medical benefits that are available are free or available at a decreased cost due to private funding or publically funded services. This includes clinics run by private charities or fund raising. The community health centers (CHC) are seeing the very poor, possibly minimally insured, chronically ill, and more minority patients.

10 COMMUNITY HEALTH NURSING ROLES 10 Housing developments have a rent according to salary system. This leads to continued poverty and needs of the population that continually needs to be addressed. Most of the population in this situation doesn t have the money to supplement insurance or obtain needed medical care. Much continued work is needed at the community level but budgetary problems continue to be a large stumbling block. Work is being done with limited finances due to community involvement and the continued work of the community health professionals.

11 COMMUNITY HEALTH NURSING ROLES 11 References Gomby, D.S., Larson, S.C., Lewit, E. M., & Behrman, R. E. (1993). Home Visiting: Analysis and Recommendations. Home Visiting, 3(3). Retrieved October 2, 2010 Maurer, F.A., & Smith, C.M. (2009). Community/Public Health Nursing Practice, health for families and populations. St. Louis: Saunders Elsevier. Perrin, J., Guyer, B., & Lawrence, J. M. (1992) Health Care Services for Children and Adolescents. U.S. Health Care for Children, 2(2). Retrieved October 2, 2010 (2009).Community-Based Care..Health Imaging.org. Retrieved September 23, 2010 from (2010).Improving Care Transitions From The Nursing Facility to a Community-Based Setting.. amda.com. Retrieved September 23, 2010, from whitepapers/transitions_of_care.cfm