Community Based Nursing and Health Maintenance – Flashcards

-Community Based Nursing- Nursing care directed toward a _____________ within the community and may be provided for __________________. -Examples: Clinics in schools, home healthcare. -Generally secondary or tertiary care. -Three different roles: community-based nursing, community health nursing, and public health nursing. Important because we are sending patients home sicker and earlier than ever before.

What are the levels of healthcare?

Health promotion, education, protection, and screening

Emergency care, acute and critical care

Rehabilitation, long-term care, hospice care

-Community-Based Healthcare- -The design, delivery, and evaluation of healthcare services developed in a partnership with communities. -Community? A workplace, a school district attendance area, enrollees of a managed care insurance provider, a geographically defined area, or a group or place identified by a categorical or medical need. ______________: A model of health determined by the U.S. Department of Health and Human Services -Set of objectives we want Americans to follow, updated every 10 years. www.odh.ohio.gov Shows concerns in OH and in the USA, educates people about OH issues.

-Community-Based Nursing- Roles?

Plan/Assess/Provide for the patient -Meds, visits, whatever patient needs we are responsible for. -Focuses on the whole person, not just health-related issues. -Case manager should have: Counseling skills, knowledge of community resources, vocational expertise, mental health expertise, sensitivity to multicultural issues, proficiency in EBP and a high level of problem-solving abilities. -Assessment, planning, coordinating, making referrals, monitoring medical progress, filing and completing paperwork, monitoring outcomes and the plan's effectiveness, determining case closure, transferring the case at closure. -Coordination

Meet with other people to talk about patient's concerns -To help resolve issues

Educate patient/family about diseases, etc... Interactive, collaborative process between the nurse and patient to progress toward the patient's goal of assuming responsibility for his or her health and self-care. Steps: Assess, negotiate, develop/implement a teaching plan, evaluate. -About what can happen

There for support -Not licensed counselors in state of OH

More on a political level but you can do in everyday instances. -For the patient -Uphold the wishes even if you feel differently the protection, promotion, and optimization of health and abilities, prevention of illness and injury, alleviation of suffering through the diagnosis and treatment of human response, and the advocacy in the care of individuals, families, communities, and populations. -promote autonomy and self-actualization -Inform, support, validate. Examples: helping the patient and family to clarify and prioritize their choices, promote optimal functioning at home, or communicate with other family members, friends, or professional services to access information or services in the home setting

What can we do to change? What needs to be done to change?

-Competencies Needed for Community-based Nursing Care- Pew Health Profession Commission- 21 competencies -Box 3-1: -Embrace a personal ethic or social responsibility and service, exhibit ethical behavior in all professional activities, provide EB, clinically competent care, incorporate the multiple determinants of health in clinical care, apply knowledge of the new sciences, demonstrate critical thinking/reflection/problem-solving skills, understand the role of primary care, rigorously practice preventative healthcare, integrate population-based care and services into practice, improve access to healthcare for those with unmet health needs, practice relationship-centered care with individuals and families, provide cultural sensitive care to a diverse society, partner with communities in healthcare decisions, use communication and information technolog effectively and appropriately, work in interdisciplinary teams, ensure care that balances individual, professional, system, and societal needs, practice leadership, take responsibility for quality of care and health outcomes at all levels, contribute to continuous improvement of the healthcare system, advocate for public policy that promotes and protects the public health, continue to learn and help others learn. -They emphasize ___________________________.

-Home Healthcare- -Characterized by a range of health issues and related services. Clients discharged from hospital early- need ______________________. Environment- ____________. Nurse is ___________ in the client's home Client abilities see box 3-2 (page 45) Blaylock Risk Assessment Screen (Brass) -Age -Living situation/social support -Functional status -Dependent in -Cognition -Behavior pattern -Mobility -Sensory Deficits -Number of previous admissions/ER visits -Number of active medical problems -Number of drugs -Score? -social workers, physical/occupational/speech therapists, and home health aides. -Integrates community health nursing principles that focus on health promotion and on environmental, psychosocial, economic, cultural, and personal health factors affecting an individual's and family's health status Patients going home sicker and earlier because insurance companies don't want to pay for long hospital stays→DRG's come into play→give facility a certain amount of money for each diagnosis -Gives nurse less time for education and more

Factors Affecting Home Healthcare Management?

High risk patients Who are you caring for? How is it working in the environment? The patient's developmental stage necessitates specific home care needs. -Patient requires physical care, but the nurse also needs to address developmental needs. Examples: -A high risk infant may require equipment to monitor breathing or to assist ventilation that is intimidating to parents. That infant however still needs closeness and bonding with parents. The nurse supports the parents to meet te infant's physical and emotional needs and encourages them to strength the parent-child bond. -A school-age chile who requires home care for either an acute or chronic condition needs support for normal socialization and peer relationships and for continuity in education. -The adolescent who is in need of long-term home care has a unique combo of support needs. May be struggling issues related to independence, peer relationships, educational demands. The nurse can assist in coordinating care needs and encouraging family and others to understand the patient's struggle and help support his/her needs.

Can the patient see? hear? smell? taste? etc.... Injury potential becomes a risk factor if any person's safety is threatened. Examples: A stairway w/o railings on which children could fall and hurt themselves. Altered health maintenance due to: -Health beliefs -Change in financial situation -Lack of supervision →impair a person's ability to live at home.

Dementia? -Getting confused, wandering at night? Sensory loss, esp blindness can hinder the ability to manage independently. Severe pain can also decrease a person's ability to carry out daily activities and functions An alteration in thought processes, if not responsive to treatment, can profoundly affect the ability to manage at home. -Dementia: Progressive condition in which memory loss and confusion greatly affect the patient's functional abilities -Mental illness: Schizophrenia and substance abuse

Break a leg? Can they do everything they need to do? ADL's? Many medical problems can impair a patient's mobility and alter self-care abilities. Can they leave house in the event of an emergency? Do housework? ADL's?

Incontinent? Who's there to help clean up? Inability to control bowel or bladder function affects the ability to manage independently in a home setting. May be secondary to some other dysfunction.

Esp elderly The inability to provide adequate nutrition impairs the patient's ability to manage independently. Buying and cooking food and cleaning up require energy. -Depression? -Financial resources? -Physical changes affecting chewing and swallowing? Can they afford good food?

-Assessment of Home Care Visit- Assess client- Can they do ADL's -Ask to describe his or er ability to manage self-care tasks -Document ability to carry out household chores independently or with assistance from others. -Determine whether the patient needs aids -Assess medications and treatments and the patient's ability to manage self-care. Assess family- Can client function at home? Support? -Strengths and barriers to home care within abilities of family members to provide care. -Characteristics that show decreased family involvement with the patient, ask directly how much support they are willing and able to provide -Observe for evidence of family visits -Observe family communication patterns and dynamics. -Assess caregivers ability and willingness to perform or to help perform any therapeutic treatments. Assess risk- Acute illness, exacerbations, unsafe neighborhoods -Multiple or catastrophic illnesses -Limited social ,mental, or physical functioning -Repeated hospital admissions within 6 months -Age older than 80 years, esp for women -Age older than 70 with a disability -Lack of social or family support and living alone -Complex medical treatment regiment and multiple medications. -Be aware of cues that indicate cognitive impairments throughout the assessment -Community deficits? unsafe neighborhoods, inadequate housing for the disable, refusal of agencies to accept difficult patients, inadequate home health services, lack of volunteer programs, long waiting lists for services, lack of affordable housing. Assess the home- Rent? Fire safety? Rodents? Heat? -Safety? Sanitation? Mobility? Temperature? Personal space? Assess community resources- ID people that need assistance -Be familiar with community resources. -Need info about community's economic stability, neighborhood, social and health resources available in the community, and the community's cultural norms.

-Community-based Healthcare Issues- Newer Community Based Settings: -_____________: Provide primary care to specific populations and staffed by NPs and community health nurses -_____________: Programs that help employees comp with personal stresses and problems -______________: emphasizes holistic care, health promotion, and disease prevention activities -______________: Primarily serves the poor and uninsured, services provided at a low cost, rely on donations or grants, and services delivered mainly by volunteer staff

-Community-based Healthcare Issues- ________________- The explosive growth of knowledge has led to specialization throughout the healthcare system. -When patient leaves hospital sick→make sure they __________________ -Example: A surgical patient with diabetes receives care from a surgeon and an endocrinologist or internist. If that same patient has heart problems during surgery, a cardiologist is called. The patient may spend time in surgery, the recovery room, the ICY, and/or a medical or surgical unit. After discharge, this fragmentation may continue as different specialists prescribe different meds and require follow up visits. →Can confuse and upset the family and compound the patient's health problems. ________________: Treatments outside Western medicine. -Examples: Acupuncture, acupressure, therapeutic touch, herbal treatments, hypnosis, imagery, homeopathy, and chiropractic ________________: Take responsibility for care -42 million Americans without healthcare→ self-care important and highly valued -Have to teach them _____________; nurses are significant position to encourage individuals, families, communities, and organizations to build on inherent strengths, capacities, and self-care abilities. _________________: Nurse at hospital who connects people to agencies when being discharged -Prepares a client to move from one level of care to another within or outside the current health-care facility. -Most successful when it is done ______________________________. __________________: -Any terminal diagnosis

Vulnerable Populations?

Truly poor

Mentally ill?

Physical/sexual

Addicts/alcohol, drugs

...

body shuts down, how do they cope?

Important to make good decisions! Bad decisions can change life→ Have to be careful

-Community Assessment- Structure: -WHEEN(B) Population: -CADGES Social System: -WATCHER(VG)

-Environmental Safety- Basic needs: -Oxygen? -Nutrition -Optimum temperature and humidity Pollution -Air pollution -Land pollution -Water pollution -Noise pollution Physical hazards -Accidents -Lighting -Obstacles -Bathroom hazards -Security: fires, lead, carbon monoxide, break-ins Transmission of Pathogens: -Exposures -Immunizations Terrorism -Bioterrorism: recognition and response

-Health and Wellness- Health and Wellness: World Health Organization (WHO) defines health as a state of _________________, not merely the absence of disease or infirmity. Wellness is defined per person in relation to ___________________.

Wellness in Healthcare

-A person is accountable for one's own health care, self-awareness is knowing and caring for oneself -First dimension of a wellness lifestyle -A personal sense of accountability for one's own well-being. -Self-awareness

-Being an active participant may help one's self-concept, this may lead to personal empowerment

-Participating in self care will give the client a feeling of independence and control -Developed in the process of caring for one's self.

-State of disharmony of mine, body, emotions, and spirit

-A product of disharmonious interaction among mind, body, emotions, and spirit -Disrupted homeostasis -Can be a signal that a person's important needs are not being met.

An action that does not meet expected norms

Life stress can affect how and when an illness is manifested Adapt strengths toward being able -Example: Helen Keller, Stevie Wonder

-Lifestyle, attitudes, and behaviors are related to well being -Self care deficit: An impaired ability to perform, or complete ADL's.

-BSE, TSE, nutrition, exercise, seatbelt, drinking, smoking

-PSA, PAP, glucose, cholesterol, STD, HTN

-Osteoporosis, hearing, vision, BP

-Normal Health Maintenance- Illness prevention: Focus on ______________________. -Example: Immunizations Health promotion: Focuses on ____________________ to prevent illness and strives toward high level wellness -Example: Rest, sleep, nutrition, exercise

-Lifespan Considerations- Newborn/Infant: Mothers ___________ during pregnancy, _______________ Toddler/Preschooler: Risk for infection, _______________. School Age/Adolescent: ________,_______,__________. Adult and Older Adult: -______________ conditions: Cancer, heart disease, diabetes, sensory impairments, confusion -______________ illnesses -Proper immunizations/boosters -___________________ in the body

-Nursing in Wellness- Three necessary behaviors?

Ability to identify what the client is feeling or experiencing without being overwhelmed or affected by the feeling

Thoughts and feelings that match the client's expression

Conveying caring without negative judgment

-Altered Health Maintenance- Chronic Illness -Examples? Injuries -Examples? Developmental Problems: -Examples? Psychosocial Problems: -Examples?

-Nursing Diagnosis-Implementation- Health promotion -___________ about illness -___________ techniques -___________ healthcare Home environment?