COMMUNITY HEALTH ROXANNE RIEDY MSN MARILEE ELIAS MSN, CNE.
Post on 26-Dec-2015
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Community
• “the gift or fellowship of common relations and feelings”(Hiemstra, 2000)
• It’s a group:–of like-minded people– that works together –who share a common language, rituals,
and customs
Population
• All the individuals inhabiting a specific area
• Leesburg, FL 22,286 (2009)
• Clermont, FL 13,252 (2009)
(www.census.gov )
Aggregate
• A group of individuals with at least one shared characteristic (personal or environmental)
• We each belong many aggregates. What are some of yours?
Community Components
Structure: general characteristics of a community, includes:
– Demographic data
– Data about healthcare services
Community ComponentsStatus: describes the outcome components
of the community
– Biological Outcome Components
– Emotional Outcome Components
– Social Outcome Components
Community Components• Process: the overall effectiveness of
the community
– Perceptions of group membership
– Extent of intergroup interactions
– Community forum for conflict resolution
Healthy People Initiatives
• We’re in the 4th decade of this national health framework for public health preventions priorities and actions.
• The overarching goals and focus topic areas are refocused every 10 years using the input from public health and prevention experts, government officials and the public.
Healthy People 2020• “The launch of Healthy People comes at a
critical time. Our challenge and opportunity is to avoid preventable diseases from occurring in the first place.” HHS Secretary Katherine Sebelius
• Use of IT to make Healthy People come alive through a “challenge” to develop ‘myHealthyPeople’ apps. (www.healthypeople.gov )
• Revision of Healthy People 2010
Healthy People 2020• 13 New Topic Areas• Main (or broad) goals of this plan:
– increase healthy life expectancy– reduce health care disparities– create social and physical environments that
promote good health for all – Promote quality of life, healthy development,
and healthy behaviors across all life stages
New Topic Areas 2020
• Adolescent Health Genomics• Blood Disorders & Blood Safety Global Health• Early and Middle Childhood Preparedness• Dementias, including Alzheimer’s Disease• Healthcare-Associated Infections• Health-Related Quality of Life and Well-Being• Lesbian, Gay, Bisexual, and Transgender Health• Sleep Health• Social Determinants of Health
Each Community also has Vulnerable
Populations
• Aggregate with increase risks for:
– Developing illness
– Adverse health outcomes
Vulnerable Populations
Vulnerability Factors:– Limited economic resources– Limited social resources– Age– Chronic disease– History of abuse or trauma
Federal Poverty Levels
• Issued each January– Range of 25% to 300% of Poverty Level– Based on Family Size– Pregnant woman= family of 2
• Low-income assistance programs base benefits on these official income levels
Community Nursing
• A Community is:
–A site for Healthcare Delivery
–A recipient of Healthcare Services
Community Based Care
• Focuses on the community • Focuses on lowering the cost of care • Healthcare Services are provided in
many types of Facilities• Acute care• Rehabilitative services
Community Based Care
Three approaches
• Community health nursing• Public health nursing • Community oriented nursing
Community Based Care
Community Health Nurse • Focus: how the Individual’s Health
affects the health of the community• Goal: maintain health of the
population• Deliver personal health services
Community Based CarePublic Health Nursing
• Focus: effect of Community’s Health on individual
• Goal: prevention of disease; promote health
• Protect health of the community• Large-scale programs
Community Based Care
Community-Oriented Nursing• Combines community and public
health• More comprehensive approach• Uses information from individuals to
change health on the community level
Community Nursing
• Empowering the Individual and the Community:– Access and Use Available Resources– Achieve/Maintain Desired Level of Health– Achieve Autonomy– Maintain Positive Self-esteem
Community Nursing Intervention Classification
• Primary (first-level)• Secondary (second-level) • Tertiary (third-level)
Community Based Careers
• School nurse• Occupational health• Parish nursing• Correctional nursing• Public health• Disaster services• International
Nursing Diagnosis
• Analyze the information, develop a list of the communities strengths and limitations
• Prioritize the information• Create a community based diagnosis
Home Health• Established in 1800’s• Growth R/T Medicare Payments (1965)• Over 132,000 RNs delivering care• Over 1,000,000 Work in Home Care• Over 12 million patients • 2009 projected costs over $72 billion
( www.nahc.org, 2012)
Home Health Care Recipients
• Individuals with skilled-care needs• Recuperating from illness or surgery• Terminal ill• On going care for individuals with
chronic illnesses in an attempt to prevent hospitalization
How do our clients get referred to home
healthcare?
• Hospital-based Referrals• Other Community Sources of Referrals• Reimbursement Evaluation
Goal of Home Health care
• Promoting self-care by:
– Fostering client independence– Completing client/family teaching– Demonstrating skill techniques– Explaining all aspects of care
Home Health Agencies
• Direct care agencies• Indirect service agencies• Types of agencies
Public
Voluntary
Proprietary
Hospital-based
Home Health Team
• RN is coordinator of health services• Multidisciplinary Team based on
patients needs
Roles of Home Health Nurse
• Direct care provider• Client /family educator• Client advocate• Care Coordinator
Hospice Nurse
• Focus is caring for pt’s who are dying or condition is not expected to improve
• Care can be provided in the hospital, home, nursing home or Hospice house
• Promote comfort & quality of life
Medicare• Individuals over 65 or• Disabled or• Diagnosis of ESRD• Largest payer- over $15 billion (2007)• Employer- over 90,000 RNs• Criteria-based Reimbursements
Medicaid
• Individuals with limited financial resources
• Sponsored by federal government and each state
• Payer for Home and Hospice Care
Private Insurance
• Sources:– Employer– Retirement Plan Benefit– AARP and other available plans
• Criteria-based Reimbursements (again)
• Documentation is Vital for Payment
Future of Home Health Care
• Expect Increased Use• Increased home Hospice care• Technological advances = safe and
affordable complex care in the home• Expanded research
Home Visit
Three phases• Preparation prior to the visit• Nursing care provided during the visit• Evaluation after the visit is completed
Home Visit
Before the visit:– Review Chart/Referral Form– Gather necessary Supplies/Materials– Assess need for additional information– Schedule Home Appointment– Assess Safety Issues
Home VisitDuring the visit:
– Make introductions– Initial Visit is vital to building trust/rapport– Be respectful of client’s home, beliefs,
practices, cultural differences– Develop a trusting relationship– Verify/complete data– Identify barriers to goals– Begin Documentation
The Home Visit Review• We’re Nurses so we:
– Assess• Client• Home Safety Issues• Infection Control Issues
– Generate Nursing Diagnoses• Risk for Caregiver Role Strain• Caregiver Role Strain
– Plan Outcomes/Evaluations– Plan Interventions/Implementation
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