community-based nursing practice. community-based nursing focused on individual and family health...
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Community-Based Community-Based Nursing PracticeNursing Practice
Community-Based NursingCommunity-Based Nursing
Focused on individual and family Focused on individual and family health needshealth needs
Moving from traditional settings to Moving from traditional settings to community/neighborhood locationscommunity/neighborhood locations
Integrated system of health care Integrated system of health care including institutions, providers, including institutions, providers, agencies, policies, payment plans, agencies, policies, payment plans, families and of course patients families and of course patients
Community-Based NursingCommunity-Based Nursing
Provides health services where Provides health services where people spend their timepeople spend their time
Traditionally such as: home (home Traditionally such as: home (home care nursing), work (occupational care nursing), work (occupational nursing), school (school nurse)nursing), school (school nurse)
Community-Based Community-Based ServicesServices
Evolved to include Evolved to include various settingsvarious settingsSenior centersSenior centersDay care centersDay care centersStorefront clinicsStorefront clinicsHomeless sheltersHomeless sheltersMental health Mental health centerscenters
Drug rehab Drug rehab programsprograms
Ambulatory care Ambulatory care centerscenters
Outreach centersOutreach centers
Institution-based Institution-based centerscenters
Parish nursingParish nursing
HospitalsHospitals
Vulnerable PopulationsVulnerable Populations
ImmigrantsImmigrants
Poor/Homeless personsPoor/Homeless persons
Abused clientsAbused clients
Substance abusersSubstance abusers
Severely mentally ill personsSeverely mentally ill persons
Older adultsOlder adults
Developmental AssessmentDevelopmental Assessment
Four stepsFour steps::1.1. Determine family’s developmental stageDetermine family’s developmental stage
2.2. Consider family member’s health problems in Consider family member’s health problems in context of tasks of their developmental stagecontext of tasks of their developmental stage
3.3. Determine if family members are meeting the Determine if family members are meeting the tasks at their tasks at their individual levels of developmentindividual levels of development
4.4. Identify nursing interventions that would Identify nursing interventions that would facilitate family meeting their developmental facilitate family meeting their developmental taskstasks
Limitations of the Developmental Limitations of the Developmental Assessment ApproachAssessment Approach
Changing demographicsChanging demographics, variations in family structures , variations in family structures (not all families fit neatly into stages)(not all families fit neatly into stages)
Nurse’s viewpoint has to take structure into account, Nurse’s viewpoint has to take structure into account, thus, assessment becomes more thus, assessment becomes more complicatedcomplicated
Family conflictsFamily conflicts cause difficulty, compounded by cause difficulty, compounded by individuals’ role disruption from illnessindividuals’ role disruption from illness
Structural Family AssessmentStructural Family Assessment
Considers composition of familyConsiders composition of family
Can be very helpful to nurse in many situationsCan be very helpful to nurse in many situations
May be a good assessment to start withMay be a good assessment to start with
Functional Family AssessmentFunctional Family Assessment
Six family functions:Six family functions:
1.1. AffectiveAffective
2.2. Healthcare and physical necessitiesHealthcare and physical necessities
3.3. EconomicsEconomics
4.4. ReproductionReproduction
5.5. Socialization and placementSocialization and placement
6.6. Family copingFamily coping
Nursing ProcessNursing Process
The purpose of writing a The purpose of writing a family nursing diagnosisfamily nursing diagnosis is is to help the family promote health through the life cycle to help the family promote health through the life cycle and prevent disease through low-risk-taking behaviorsand prevent disease through low-risk-taking behaviors
In planning phase, delineate expected outcomes for In planning phase, delineate expected outcomes for family health; Use family health; Use mutual goal-settingmutual goal-setting with family with family
Process of collaborative goal-setting should have Process of collaborative goal-setting should have positive influence on nurse’s interactions with familiespositive influence on nurse’s interactions with families
Also facilitates adherence to agreed-upon plan of careAlso facilitates adherence to agreed-upon plan of care
Remember: Assessment is a two-way enterprise; the Remember: Assessment is a two-way enterprise; the family is assessing you, as wellfamily is assessing you, as well
Examples of Family Nursing Examples of Family Nursing DiagnosisDiagnosis
TheoreticalTheoretical ModelModel
StageStage HealthHealth StatusStatus
PatternPattern ProblemProblem
DevelopmentalDevelopmentalFamily withFamily withPreschoolersPreschoolers
Potential forPotential forphysical injuryphysical injury
Health-Health-Perception-Perception-HealthHealthManagementManagement
Medications &Medications &poisonous poisonous cleaningcleaningsubstances substances within reach of within reach of childrenchildren
Family withFamily withadolescentsadolescents
PotentialPotentialalteration inalteration inparentingparenting
Roles-Roles-relationshipsrelationshipspatternpattern
Value systems Value systems ofofParents & Parents & adolescent adolescent members in members in conflictconflict
Risk FactorsRisk Factors Young coupleYoung couple Compromised &Compromised &ineffectiveineffective
Coping-Coping-stress-stress-tolerance tolerance patternpattern
Teenage Teenage marriagemarriagePregnancy Pregnancy before age 16before age 16
From: C. Edelman & C. Mandle (2002) Health promotion throughout the lifespan. St. Louis: Mosby.
Steps in the Planning ProcessSteps in the Planning Process
1.1. Prioritize problems & potential problemsPrioritize problems & potential problems
2.2. Determine which items can be handled by the nurse Determine which items can be handled by the nurse and the family, and items that must be referred to and the family, and items that must be referred to othersothers
3.3. Decide on actions and expected outcomesDecide on actions and expected outcomes
GoalsGoals
Goals describe a desired outcomeGoals describe a desired outcome
Goal statements include:Goal statements include:– The expected behaviors of the familyThe expected behaviors of the family– The circumstances under which the behaviors will be The circumstances under which the behaviors will be
demonstrateddemonstrated– Criteria by which to determine when and how the Criteria by which to determine when and how the
behaviors will be performedbehaviors will be performed
Health promotion goals reflect a desire to function Health promotion goals reflect a desire to function at a higher level of health and to grow beyond at a higher level of health and to grow beyond maintaining health or preventing diseasemaintaining health or preventing disease
Implementation With The FamilyImplementation With The Family
Family nursing interventionsFamily nursing interventions aim to assist family aim to assist family members in carrying out functions that the members members in carrying out functions that the members cannot perform for themselvescannot perform for themselves– Health promotion: Health promotion: the nurse assists the family in the nurse assists the family in
improving their capacity to act on its own behalfimproving their capacity to act on its own behalf
Three Broad Categories of Interventions with Three Broad Categories of Interventions with FamiliesFamilies– Cognitive interventionsCognitive interventions– Affective interventionsAffective interventions– Behavioral interventionsBehavioral interventions
Four Types of Interventions are Four Types of Interventions are Found in Health Found in Health
Promotion/Disease PreventionPromotion/Disease Prevention
Increasing knowledge and skillsIncreasing knowledge and skills
Increasing strengthsIncreasing strengths
Decreasing ExposureDecreasing Exposure
Decreasing susceptibilityDecreasing susceptibility
Evaluation With The FamilyEvaluation With The Family
Purpose of evaluation is to determine how the family has Purpose of evaluation is to determine how the family has responded to the planned interventions. Concrete objectives are responded to the planned interventions. Concrete objectives are easier to measureeasier to measure
Family’s baseline data needs to be used as comparative criteria Family’s baseline data needs to be used as comparative criteria in evaluationin evaluation
Five measures of family functioning that can be used to Five measures of family functioning that can be used to determine effectiveness of interventionsdetermine effectiveness of interventions
1.1. Changes in interaction patternsChanges in interaction patterns2.2. Effective communicationEffective communication3.3. Ability to express emotionAbility to express emotion4.4. Responsiveness to needs of members as individualsResponsiveness to needs of members as individuals5.5. Problem-solving abilityProblem-solving ability
If goals are not met, review processIf goals are not met, review process
Health Promotion/Prevention Health Promotion/Prevention Strategies as Applied to the FamilyStrategies as Applied to the Family
Primary PreventionPrimary Prevention Completing a family genogram and assessing health risks Completing a family genogram and assessing health risks
with the family to contract for family health activities to with the family to contract for family health activities to prevent diseases from developingprevent diseases from developing
Secondary PreventionSecondary Prevention Using a behavioral health risk survey and identifying the Using a behavioral health risk survey and identifying the
factors leading to obesity in the familyfactors leading to obesity in the family
Tertiary PreventionTertiary Prevention Developing a contract with the family to change nutritional Developing a contract with the family to change nutritional
patterns to reduce further complications from obesitypatterns to reduce further complications from obesity
Three Levels of PreventionThree Levels of Prevention
Adults age 65 and over who ever received Adults age 65 and over who ever received pneumococcal vaccination, 1999-2006pneumococcal vaccination, 1999-2006
Source:Source: Centers for Disease Control and Prevention, National Center for Centers for Disease Control and Prevention, National Center for
Health Statistics, National Health Interview Survey, 1999-2006Health Statistics, National Health Interview Survey, 1999-2006. .
Components of a Community Components of a Community AssessmentAssessment
Community:Community: an entity made up of people, a place, and an entity made up of people, a place, and social systemssocial systems
The characteristics of a The characteristics of a “healthy community”“healthy community” can be can be used to assess a community’s healthused to assess a community’s health
Community assessment is a Community assessment is a problem-solving processproblem-solving process similar to the nursing processsimilar to the nursing process
Community AssessmentCommunity Assessment
Community-based vs community-oriented Community-based vs community-oriented nursingnursing
All three dimensions of community are assessed:All three dimensions of community are assessed:– The peopleThe people– The placeThe place– The social systemsThe social systems
Community assessments vary in scope and Community assessments vary in scope and complexity; nurse’s role depends on nurse’s complexity; nurse’s role depends on nurse’s educational preparation and expertiseeducational preparation and expertise
PeoplePeople
Demographic characteristics: Demographic characteristics: number, number, composition by age, rate of growth and decline, composition by age, rate of growth and decline, social class and mobility of people in the social class and mobility of people in the communitycommunity
Other vital statistics: Other vital statistics: birth rate, overall death birth rate, overall death rate, death rate by cause and age, and rate, death rate by cause and age, and infant infant mortality ratemortality rate• Infant mortalityInfant mortality rate rate is considered to be the is considered to be the
most important statistical indicator of maternal-most important statistical indicator of maternal-infant health in the communityinfant health in the community
PlacePlace
Where Where the community is located and its boundariesthe community is located and its boundaries
Type Type of community (e.g., rural or urban)of community (e.g., rural or urban)
Location of health servicesLocation of health services
Climate: Climate: flora, fauna & topographyflora, fauna & topography
Social SystemsSocial Systems
EconomicEconomic
EducationalEducational
ReligiousReligious
PoliticalPolitical
LegalLegal
Human servicesHuman services
RecreationRecreation
CommunicationCommunication
systemssystems
Epidemiology:Epidemiology:
““The study of the distribution and determinants of health-The study of the distribution and determinants of health-related states or events in specified populations, and the related states or events in specified populations, and the application of this study to control of health problems”application of this study to control of health problems”
Descriptive Epidemiology:Descriptive Epidemiology:
Study of the distribution of disease and other health-Study of the distribution of disease and other health-related states in terms of:related states in terms of:
– personal characteristics personal characteristics (person)(person)
– geographical distribution geographical distribution (place)(place)
– temporal patterns temporal patterns (time)(time)
Analytic epidemiology:Analytic epidemiology:
Studies the origins and causal factors of disease and Studies the origins and causal factors of disease and other health-related states and eventsother health-related states and events
The Epidemiologic TriangleThe Epidemiologic Triangle
Represents complex Represents complex relationships among:relationships among:
– causal agentscausal agents
– susceptible personssusceptible persons
– environmental environmental factorsfactors
Stages of Health and PreventionStages of Health and Prevention
SusceptibilitySusceptibility Primary Primary
preventionprevention
AsymptomaticAsymptomatic Secondary Secondary
diseasedisease prevention prevention
ClinicalClinical Tertiary Tertiary
manifestationsmanifestations prevention prevention