Chapter 2 Community Based Nursing Practice

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By nclexnursing

Community-based nursing practice. The need for care in ambulatory settings and at home has increased as the health care system has changed over the last two decades. As a result of these changes, nurses who are highly skilled and well-prepared to deliver community-based care are in high demand.

The Growing Need for Community-Based Health Care

Changes in federal legislation, tighter insurance rules, declining hospital revenues, and the development of alternative health care delivery systems have all contributed to the shift in health care delivery settings outlined in Chapter 1. Hospitals and other healthcare providers are now reimbursed at a predetermined rate for patients with the same diagnosis as defined by diagnosis-related groups, thanks to federal legislation passed in 1983 and 1997. Hospitals and other healthcare providers can save money and make money under this system by carefully monitoring the services they give and discharging patients as soon as possible.

Alternative health-care delivery methods, such as managed-care systems, have also helped to ameliorate the situation. The first chapter delves more into the various healthcare system possibilities. Individual and family care is founded on the principle of community-based nursing. As the individual or family moves between various types of service providers outside of hospitals, the care is offered in the community. Independent decision-making, critical thinking, assessment, and basic nursing care are all necessary skills for providing care in a community context.

Community-Based Care

Individuals and groups’ health is promoted and maintained, illness progression is prevented and minimized, and quality of life is improved in community-based nursing practice. The community health nurse can work as an epidemiologist, a case manager, or a coordinator of services for a group of people.

Home Health Care

Home health care is quickly gaining popularity as a nursing specialty. Due to the high acuity level of patients, nurses with acute care and high-technology abilities are in high demand in this field. Although primary and secondary prevention are also included in care, home care nurses prioritize tertiary preventive nursing care, which focuses on rehabilitation and restoring maximum health function. Health care visits might be infrequent or periodic, and telephonic case management can be used to increase interaction with home care clients.

Discharge Planning of Home Care

Discharge planning begins with the patient’s admission to prepare for an early hospital discharge and the potential need for home follow-up care. The planning process may involve a number of different people or organizations. Discharge planners in hospitals may be social workers or nurses. Liaison nurses collaborate with discharge planners at some home care organizations to ensure that the patient’s needs are satisfied when he or she is discharged from the hospital. Patients may be referred to home care services by professionals in ambulatory health care facilities to avoid hospitalization. Patients referred for anticipatory assistance with high-risk families, case discovery, and follow-up therapy are cared for by public health nurses (eg, patients with communicable diseases).

Community Resources and Refferal

Case managers include home health nurses and public health nurses. They may recommend the patient to other team members, such as home health aides and social workers, after analyzing the patient’s needs. They collaborate with the patient’s health care team as well as the agency or person who referred the patient for help. To avoid duplication of effort by the numerous staff caring for the patient, continuous coordinated care among all health care providers participating in the patient’s care is vital.

Hospital and Community-based Nursing

Nursing care in a patient’s home is not the same as nursing care in a hospital. To stay in a hospital and receive treatment, patients must sign a release form. They have little say over what happens to them and are expected to follow the hospital’s rules, regulations, and activity schedule. They sleep in hospital beds and frequently dress in hospital robes or clothing.
They receive care, treatments, showers, and medications at times dictated by institutional timetables rather than the patient’s convenience. Although hospitalized patients have the option of choosing meals from a daily menu, the types of food available to them are limited. During the hospital’s visiting hours, family and friends are welcome to visit.

Preparing for Home Visit

The majority of agencies have a policy manual that outlines their philosophy, procedures, and services. Before beginning a house visit, it is critical to familiarize yourself with these policies. Knowing the agency’s regulations and state law regarding what to do if a patient is found dead experiences an abusive scenario in the family, or determines that a patient cannot safely remain at home is also vital. Before conducting a home visit, the nurse should go over the patient’s referral paperwork as well as any other necessary information. If the objective of the referral is unclear or critical information is lacking, it may be required to contact the referring agency.

Conducting a Home Visit

Personal Safety Precautions

Initial Home Visit

Determining the Needs for Future Visits

Closing the Visit