Community

Community Health
Health
Nursing
Nursing
System
System and
and Process
Process
Community-based, Population-
focused Health Care Delivery
Definitions

• Community-based Nursing
– “a philosophy of nursing that guides nursing
care provided for individuals, families and
groups wherever they are, … where they
work, play, live or go to school.”
 Community Health
Nursing
• A specialty in nursing and an umbrella
term.
• Some believe that CHN is synonymous
with Public Health Nursing.
– “A comprehensive and general practice that
promotes and preserves the health of
populations by integrating skills and
knowledge relevant to both nursing and public
health.”
 Population-based
Nursing
• “A wellness-oriented approach to
practice.”
– “directed toward identification of high-risk
groups and collaboration with
interdisciplinary teams to plan and
coordinate programs . . that address actual
and potential health problems.”
• Not to be confused with definitions of
specific aggregates and total
populations.
The Umbrella Concept of Community Health Nursing
 The Home Visit
• “Visit” or “visiting” definition:

The verb implies action, “to go to

see”.
The noun implies an event, “a short
stay”.
 “Visiting”:
Multiple meanings:
1. Chatting with, influencing, observing,
inspecting or investigating.
2. May vary from formal to informal
3. Social, spiritual, comfort, caring (as in
charitable work, professional services and
official, observational purposes).
4. Outcomes may be positive (caring, helping, or
comforting)
5. Outcomes may be negative (afflicting,
imposing, or harming)
 The Emerging Concept
of Home Visiting
• An antecedent event: The nurse
becomes aware of the client or
family needing or desiring a visit.
 The Phases of Home
Visiting
• The Contacting Phase
Going to see
Journey to home/family (community
assessment)
Approaching the family (knocking on the
door)
 The Entry Phase
Seeing

Observing

Experiencing

Interacting
The Terminating Phase
Telling
Letting others know of family’s
needs
Realization of the need for social
reform
Documentation
Referral
 Other Concepts of Home
Visiting
• More than just an alternative setting for service

• An intervention modality

• A modality for promoting family health

• A nursing intervention

• A process with distinct, labeled phases and specific nursing activities for each

• Entry involves not only gaining access to the client’s home but also entering into
the client’s life situation

• A unique opportunity insight and understanding, when interacting in the client’s

own environment

• Gaining appreciation for the client’s world view

• A feeling of shared humanity

 The Referral Process
• Definition:
– “A systematic problem-solving approach
involving a series of actions that help clients to
utilize resources for the purposes of resolving
needs”
• Goal:
– The nurse directs the client to a service or
resource, with the goal of promoting high level
wellness and enhancing self-care capabilities
and quality of care.
 What does it take?
• It’s more than completing a form and
telling the client to contact an agency.
• Knowledge of community resources
• Ability to problem-solve
• Set priorities
• Coordinate & Collaborate
• A “Referral System”
The referral should be:
1. merited
2. practical
3. tailored to the client
4. up to the client to say “yes” or “no”
5. timely
6. coordinated with other activities
7. incorporated, so the client has input into the
planning and implementation process.
 Steps of the Referral
Process
• Establish a working relationship with the client
• Establish the need for the referral
• Set objectives for the referral
• Explore resource availability
• Remember that the client can choose whether
or not to use the referral
• Make the referral to the resource
• Facilitate the referral
• Evaluate and follow-up
 Remember
• referral without
follow-up is useless.
 The Referral System
• Determine the types of services that will be needed
• Locate services in the community
• Collect information about the services
(keep them current)
• Determine the appropriateness and quality of the
services
• Develop a referral “list”
• Develop a referral protocol
• Develop a follow-up system
• Train people to make referrals
• Update the referral list and referral information
Gain Access to Resources
in the Community
• Important concepts:
– Agencies provide services that the
nurse cannot.
– Referrals improve the client’s ability
to initiate self-care.
– Referral information is usually out-of-
date after the first time you make
contact.
 Resource Files:
1. Name, address, phone number, directions to the
facility (i.e.: bus route, cross-street)
2. Person in charge of the agency or contact person for
client (this may be the “first person” who answers the
phone or a specific individual).
3. Purpose and services of the agency
4. Eligibility criteria
5. Application procedure
6. Fee or payment schedule
7. Date and initials of person compiling/updating the
information
 Client-Oriented Roles
• “Involve direct provision of client
services to individuals, families and
occasionally groups” (Clark, 2003)
• One way of providing population
based care
 Client-Oriented Roles
• Caregiver
• Educator
• Counselor
• Referral resource
• Role model
• Advocate
• Primary care provider
• Case manager
 Delivery-oriented Roles
• Enhances the operations of health
care delivery and which results in
better care for clients (Clark, 2003)
 Delivery-oriented Roles
• Collaborator
• Coordinator/Care Manager
• Liaison
 Population-based Roles
• Differ from client and deliver
oriented roles. (client & family focus)
• Actions/roles relate to populations
and groups
• Changes in larger social and
environmental factors that affect
health (Clark, 2003)
 Tenets of Public Health
Nursing
• Population-based assessment, policy development&
assurance
• Partnering with representatives of the people
• Priority = Primary prevention
• Interventions are selected to increase healthy
conditions in in the environment, society, &
economics.
• Outreach to marginal and at-risk communities
• Greater good over individual-social justice
• Collaboration with other professions and
organizations
 Population-based Roles
• Case finder
• Leader
• Change Agent
• Community Developer
• Coalition Builder
• Researcher