Chapter 2

Community-Based
Nursing Practice

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Factors That Have Increased the Need for
Community Health Care

 New population trends

o Aging population
 Changes in federal legislation
 Tighter insurance regulations
 Decreasing hospital revenues

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Key Components of
Community-Based Care #1

 Promoting and maintaining health of individual and family

o Self-care
 Preventive care within content of community, culture
 “Upstream thinking”

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Levels of Preventive Care

 Primary
 Secondary
 Tertiary

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Question #1

Which nursing intervention is an example of secondary

prevention?
A. Teaching a group of older adults about a heart healthy
diet
B. Screening school-aged children for scoliosis
C. Rehabilitation for a patient after recovery from a stroke
D. Teaching an adult patient about the need to be
immunized with the flu vaccine annually

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Answer to Question #1

B. Screening school-aged children for scoliosis

Rationale: Secondary prevention centers on health
maintenance and is aimed at early detection and prompt
intervention to minimize illness or disease. Screening for
scoliosis in children can help identify this problem so that
the child can be referred in order to minimize long-term
complications. Health teaching is considered primary
prevention. Rehabilitation is considered tertiary prevention
because it focuses on minimizing deterioration.

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Key Components of
Community-Based Care #2

 Promoting and maintaining health of individual and family

o Self-care
 Preventive care within content of community, culture
 “Upstream thinking”

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Discharge Planning

 Transition from acute care to community setting

 Begins on admission to acute care
 Collaborative care
 Family participation

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Community Resources

 Referrals
 Continuous coordination
 Community directory/resource book
 Resources
o Grocery/drug stores
o Banks
o Social service agencies
o Senior citizen programs

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Home Health Care

 Holistic
 Interdisciplinary
 Reimbursement
o Medicare (OASIS)
o Private Insurance
o Direct-pay
 Nursing Services
o Skilled nursing, Follow-up Care, Teaching, Hospice
 Tele-health fast emerging

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The Home Setting

 Nurse = Guest
 Deliver care regardless of conditions
 Equipment and supplies
o Improvisation
 Infection control
 Confidentiality
 Home health agency policy manual

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Preparing for a Home Visit

 Review referral
 Call patient to obtain permission
 Assure bag is stocked with supplies and equipment

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Conducting a Home Visit

 Personal safety
 Initial visit
o Establish plan of care
 Determine need for future visits
 End visit
o Main points, positive attributes identified,
teaching/treatment plan, when to call someone, and
return visit information
 Documentation

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Question #2

What nursing intervention best illustrates the protection of

patient confidentiality in the home care setting?
A. Only providing positive information to the patient’s
family
B. Leaving the patient’s chart in the trunk of the car before
entering the home
C. Allowing the neighbors into the home during the visit so
that the patient can discuss the situation
D. Placing the medical record in a secure place within the
home

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Answer to Question #2

D. Placing the medical record in a secure place within the

home
Rationale: The home care patient has a right to
confidentiality and information should only be shared with
patient permission. The nurse may need the chart;
therefore, leaving it in the trunk may not be the best
intervention. Allowing the neighbors into the home does
not respect the patient’s privacy.

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Home Visit Precautions

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Question #3

What are appropriate safety precautions when caring for a

patient in the home?
A. Do not carry a phone into the patient’s home because it
may be distracting.
B. Park the car in a lighted area even if it is a good distance
from the home.
C. Try to schedule visits in the daylight hours when
possible.
D. Drive an expensive car so that neighbors will know you
are on official business.

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Answer to Question #3

C. Try to schedule visits in the daylight hours when

possible.
Rationale: Less crime and better visibility are factors to
scheduling visits during the daylight hours. Nurses should
carry phones for emergencies, should park close to the
patient’s home, and should not drive expensive cars when
making home visits.

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OTHER Community-Based Health Care

 Hospice
 Ambulatory settings
 Occupational health programs
 School health programs
 Community nurse-managed centers
 Care for the homeless

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Hospice Care

 Patient’s within final 6 months of life

 Nurses Role
o Education
o Support
o Coordination
 Rural communities—limited access
 Refer to Charts 2-4 and 2-5

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Ambulatory Settings

 Medical clinics
 Ambulatory care units
 Urgent care centers
 Rehab programs
 Mental health centers
 Student health centers
 Community outreach programs
 Affordable, accessible health care

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Occupational Health Programs

 Occupational Safety and Health Act (OSHA)

 Occupational health nurses
o Solo units in industrial settings
o Consultants
 Interdisciplinary team approach
 Direct care to ill/injured employees
 Health education programs
 Knowledge about federal regulations required (i.e.,
Americans With Disabilities Act)

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School Health Programs

 Interdisciplinary health team

 Primary health clinic on site
o Utilization of advanced practice nurses
o Cost-effective
 School nurses
o Collaborate
o Perform health screenings and provide basic care
o Health education consultants for children with chronic
disease (i.e., asthma)

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Care for the Homeless

 Underinsured or uninsured
 Limited to no access to health care
 Seek health care late in the course of a disease
 Deteriorate more quickly
 Shelters—communicable disease
 Lower life expectancy
 Nurses role
o Skilled, unpredictable environments, nonjudgmental
care

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