Community Health Community Health Nursing Nursing

System and ProcessSystem and Process

Community Health Community Health Nursing Nursing

System and ProcessSystem and ProcessUnit 2Unit 2

Community-based, Population-focused

Health Care DeliveryDefinitions

• 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 informal3. 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 PhaseGoing to seeJourney to home/family (community assessment)Approaching the family (knocking on the door)

The Entry PhaseSeeing

Observing

Experiencing

Interacting

The Terminating PhaseTellingLetting others know of family’s needsRealization of the need for social reformDocumentationReferral

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. merited2. practical3. tailored to the client4. up to the client to say “yes” or “no”5. timely6. coordinated with other activities7. 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 agency4. Eligibility criteria5. Application procedure6. Fee or payment schedule7. 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