TERNOPIL STATE MEDICAL UNIVERSITY

INSTITUTE OF NURSING

DEPARTMENT OF CLINICAL IMMUNOLOGY, ALLERGOLOGY

AND GENERAL PATIENT CARE

 

Lecture 10

 

Settings for Community Health Nursing

 

After studying this chapter, you should be able to:

 

·        Identify what is home health and hospice care.

·        Describe community health in the schools

·        Describe occupational health

·        Analyze other community health nursing roles

 

 

 

 

 

What is Home Health?

 Home care is a broad term that describes a great variety of services provided in the home setting. Services are provided by a number of different types of organizations and agencies. Among the most common are Home Health, Hospice, Chore, and Meals on Wheels, Respite Care, Private Duty nursing agencies and others.

Home care is one of the oldest forms of health care. The term “home care” goes back as far as the first century when a group of women known as deaconesses developed a program to care for the ill in their homes.

Today home health care may be considered for patients who are:

• recovering from an illness.

• undergoing treatment.

• disabled.

• chronically ill.

• terminally ill.

Home health care is not an option for everyone. Generally, the patient receiving care or treatment at home must be well enough to be cared for in the home setting.

With the advent of Medicare and Medicaid in 1965, home health care became a growing industry.

 

Home Health Care has been primarily defined by Medicare as intermittent or “Per Visit” services, as opposed to continuous or hourly services, by Nurses, Physical Therapists, Speech Therapists, Occupational Therapists, Medical Social Workers, and Home Health Nursing Assistants to persons confined to their homes and ieed of short term acute health care. Changes in technology have continually expanded the range of services that can be provided within the home setting. New technology makes it possible for persons to recover at home who previously would have remained in hospitals or other facilities. The possibilities for home care are unlimited, but actual delivery of services is greatly influenced by policies established by the major payors of home health services.

The majority of home health today is focused on the elderly and disabled. However, there is increasing interest in providing pediatric, maternity, and psychiatric care in the home. Patients who are dependent upon ventilators, intravenous or tube feedings and other specialized equipment are provided competent and quality services in the home. This allows the patient to remain a part of their family and community rather than be confined to a facility. Many agencies have specialized to provide only specific types of services while others have expanded their scope of services to provide the widest possible choice for their patients.

 

Types of home health care services:

 Many types of medical and social home health care services are available and may include:

·        physician care

·        nursing care

·        physical, occupational, and/or speech therapy

·        medical social services

·        care from home health aides

·        homemaker or attendant care

·        companionship

·        volunteer care

·        nutritional support

·        medical equipment and supplies

·        laboratory and x-ray imaging

·        pharmaceutical services

·        transportation

·        home-delivered meals

A patient may receive one of these services or a combination of several services.

 

“The purpose of home health care is to provide the support, treatment, and information those caregivers and patients need to successfully manage their healthcare needs at home. The home health nurse’s role is that of facilitator of home independence through patient education, patient advocacy, and case management.”

                                                             Robyn Rice

 

What to expect in Home Health Nursing

 

What is Hospice?

 The concept of hospice has been a part of the way people have helped each other for generations. The word comes from “hospitality,” signifying care given to travellers and strangers. Today, the concept of hospice has become associated with a way of caring for terminally ill people and their families. The coordinated program of services called hospice is designed to meet the physical, emotional, social, and spiritual needs of patients and families in their final days of life. The hospice concept says the final stages of life should be lived fully, with as much comfort and dignity as possible.

 

Settings for hospice care:

Although most patients receive hospice care at home, hospice care can also take place in other settings, including:

• hospital-based hospice

Most hospitals have a hospice program to give terminally ill patients access to support services and other health care professionals.

Some hospitals even have a special hospice unit.

• long-term care hospice

Many nursing homes and long-term care homes have hospice units with specially trained staff for those patients who do not have a primary caregiver at home, or who require medical services not suitable for a home setting.

• freestanding hospices

Independently owned hospices may sometimes include an inpatient care facility, in addition to their home care hospice services. The inpatient facilities offer patients hospice services when a primary caregiver is not available at home, or the patient requires medical services not suitable for a home setting.

 

Hospice is a special kind of caring for dying people, their families and caregivers. Hospice:

		creates the physical, emotional, social and spiritual needs of patients and families
		takes place in a patient’s home or home-like setting
		helps make the patient as free of pain as possible so they can make the most of each day
		focuses on support of the family
		believes quality of life is as important as length of life

 

Hospice is also a movement.

Dame Cicely Saunders founded the first modern hospice in London in 1968 the movement spread to the United States in the early seventies. Modern medicine had made major advances, including the hospital as the primary place for healthcare, including deaths. In former times, the home and family had been the primary place where people died and families gave care. Clergy, healthcare workers and others grew concerned that the dying process might be completed better outside of hospital environments. Patients and families would have more control over the final days and hours. Out of these concerns and the London work of Dame Cicely, the modern hospice movement in the United States was born. Today, patients who choose hospice care die at home or in a hospice facility, rather than in a hospital. 3HC strives to meet all needs expressed in The Dying Person’s Bill of Rights.

The hospice team primarily provides services in a person’s private residence. However, many patients are served who reside in rest homes, assisted living homes, and skilled nursing homes. 3HC, Home Health and Hospice Care, Inc., is also proud to offer services in the first hospice inpatient facility in eastern North Carolina and one of only a few in the state, the Kitty Askins Hospice Center.

Most insurance plans include coverage for hospice. Medicare, Medicaid and TriCare offer a comprehensive hospice benefit. Under these plans, the patient has 100% coverage with only a five percent (5%) or $5 co-payment for medication and respite care. However 3HC does not choose to charge the patient for these co pays. Therefore, the patient and family receive these comprehensive services with no deductible and no co-payment. Other insurance plans vary and hospice will help in investigating coverage. Many donations are made to 3HC hospice so that inasmuch as possible, services can be provided regardless of a patient’s ability to pay.

Hospice defines palliative care as comfort care or an intensive program of care with the relief of pain and suffering as the treatment goal. When cure is no longer possible, a peaceful and comfortable life and death is the treatment objective.

Modern health care recognizes palliative care as a valid treatment goal. However, many health care professionals, including physicians, have not been trained to provide palliative care. The expertise of hospice clinicians is in palliative care. Hospice believes that death is a normal part of the life cycle. Our goal in hospice care is to manage pain, ease suffering (physical, emotional, social, and spiritual) and support the patient and family in living fully and as completely as possible in the final months.

 

 The concepts of hospice nursing remain the same whether hospice care is provided on an inpatient basis, or in the home. These nurses should be knowledgeable in pain management, and have good psychosocial skills. Clients and their families are often in crisis, and require a great deal of emotional support. Hospice nurses are more likely to experience emotional burnout, and may benefit from spending time in other fields of home health nursing from time to time. Hospice nurses must take call, and in some states, like NJ, are responsible for pronouncement of death

 

Occupational health

 Occupational health is concerned with the health and safety of employees at work. The aim of the occupational health services is to promote a healthy, safe and satisfactory work environment, and a healthy, active and productive worker. However, there are workplaces that are unsafe and that affect the health of the workers.

Occupational health professionals (doctors/nurses) at all health facilities are trained to identify, diagnose, treat and rehabilitate employees who have chronic diseases and injuries as a result of being injured in the workplace or being exposed to hazardous substances at work.

Occupational health is a vital component of HR policy, enabling employers to understand and comply with Health and Safety legislation and to ensure workplace risks are effectively managed. Other areas in which occupational health advice can assist organizations include rehabilitation and medical intervention programmers, disability adjustments, ill-health retirement issues and the management of existing work-related health problems.

Occupational health problems occur at work or because of the kind of work you do.

These problems can include

1. Cuts, broken bones, sprains and strains, or amputations

2. Repetitive motion disorders

3. Hearing problems caused by exposure to noise

 

Noise

Noise is all around you, from televisions and radios to lawn mowers and washing machines. Harmful sounds – sounds that are too loud or loud sounds over a long time – can damage sensitive structures of the inner ear and cause noise-induced hearing loss

Hearing loss it’s frustrating to be unable to hear well enough to enjoy talking with friends or family. Hearing disorders make it hard, but not impossible, to hear. They can often be helped. Deafness can keep you from hearing sound at all.

What causes hearing loss? Some possibilities are

• Heredity

• Diseases such as ear infections and meningitis

• Trauma

• Certain medicines

• Long-term exposure to loud noise

• Aging

There are two main types of hearing loss. One happens when your inner ear or auditory nerve is damaged. This type is permanent. The other kind happens when sound waves cannot reach your inner ear. Earwax build-up, fluid or a punctured eardrum can cause it. Untreated, hearing problems can get worse. If you have trouble hearing, you can get help. Possible treatments include hearing aids, special training, certain medicines and surgery.

 

More than 30 million people in the U.S. are exposed to hazardous sound levels on a regular basis. Hazardous sound levels are louder than 80 decibels, which isn’t as loud as traffic on a busy street. Listening to loud music, especially on headphones, is a common cause of noise-induced hearing loss. Keeping the volume down when listening to music and wearing earplugs when using loud equipment can help protect your hearing

 

4. Vision problems or even blindness

5. Illness caused by breathing, touching or ingesting unsafe substances

6. Illness caused by exposure to radiation

It’s frustrating to be unable to hear well enough to enjoy talking with friends or family. Hearing disorders make it hard, but not impossible, to hear. They can often be helped. Deafness can keep you from hearing sound at all.

What causes hearing loss? Some possibilities are

• Heredity

• Diseases such as ear infections and meningitis

• Trauma

• Certain medicines

• Long-term exposure to loud noise

• Aging

There are two main types of hearing loss. One happens when your inner ear or auditory nerve is damaged. This type is permanent. The other kind happens when sound waves cannot reach your inner ear. Earwax build-up, fluid or a punctured eardrum can cause it. Untreated, hearing problems can get worse. If you have trouble hearing, you can get help. Possible treatments include hearing aids, special training, certain medicines and surgery.

 

7.     Exposure to germs in healthcare settings

 

 Occupational Health for Healthcare Providers

Healthcare workers are exposed to many job hazards. These can include

• Infections

• Needle injuries

• Back injuries

• Allergy-causing substances

• Violence

• Stress

Follow good job safety and injury prevention practices. They can reduce your risk of health problems. Use protective equipment; follow infection control (Infection Control Every year, many lives are lost because of the spread of infections in hospitals. Health care workers can take steps to prevent the spread of infectious diseases. These steps are part of infection control. Proper hand washing is the most effective way to prevent the spread of infections in hospitals. If you are a patient, don’t be afraid to remind friends, family and health care providers to wash their hands before getting close to you.

Other steps health care workers can take include:

• Covering coughs and sneezes

• Staying up-to-date with immunizations

• Using gloves, masks and protective clothing

• Making tissues and hand cleaners available

• Following hospital guidelines when dealing with blood or contaminated items

) guidelines, learn the right way to lift heavy objects, and find ways to manage stress.

 

 Occupational Health Nurses (OHN) are registered nurses who independently observe and assess the worker’s health status with respect to job tasks and hazards. Using their specialized experience and education, these registered nurses recognize and prevent health effects from hazardous exposures and treat workers’ injuries/illnesses.

 

 

Scope

Educationally prepared to recognize adverse health effects of occupational exposure and address methods for hazard abatement and control, OHNs bring their nursing expertise to all industries such as meat packing, manufacturing, construction as well as the health care industry.

·        OHNs:

o       Have special knowledge of workplace hazards and the relationship to the employee health status.

o       Understand industrial hygiene principles of engineering controls, administrative controls, and personal protective equipment.

o       Have knowledge of toxicology and epidemiology as related to the employee and the work site.

 

Typical OHN Activities:

• Observation and assessment of both the worker and the work environment

• Interpretation and evaluation of the worker’s medical and occupational history, subjective complaints, and physical examination, along with any laboratory values or other diagnostic screening tests, industrial hygiene and personal exposure monitoring values

• Interpretation of medical diagnosis to workers and their employers

• Appraisal of the work environment for potential exposures

• Identification of abnormalities

• Description of the worker’s response to the exposures

• Management of occupational and non-occupational illness and injury

• Documentation of the injury or illness

• assessing the work environment for potential health and safety problems;

• designing, developing and delivering new initiatives, policies and procedures on health education/promotion and accident/disease prevention;

• conducting a range of assessments and inspections, in conjunction with regulations, such as display screen equipment (DSE), personal protective equipment (PPE) and the control of substances hazardous to health (COSHH);

• delivering health and safety training;

• providing first aid and medical treatment;

• communicating safety concerns to appropriate managers;

• maintaining employee health records and preparing accident reports;

• conducting accident investigations;

• investigating the causes of common injuries;

• providing pre-employment medicals/physicals, including hearing and vision screening, and health and fitness advice;

• maintaining first-aid kits, ordering new supplies and destroying out-of-date items as necessary;

• assisting injured employees returning to work from medical leave;

• monitoring employee exposure to hazardous chemicals;

• contacting doctors and/or hospitals, as necessary, to arrange further treatment;

• keeping up to date with legal and professional changes associated with occupational health and safety;

• using expertise to ensure organisations meet legislative requirements.

 

Academic Preparation

OHNs with varying degrees of academic preparation from entry level to PhD work in capacities commensurate with their experience and academic preparation: clinical nurse, clinical nurse manager, nurse manager, corporate nurse, nurse researcher, nurse educator and nurse consultant.

• Education and Resource Centers (ERCs). National Institute for Occupational Safety and Health (NIOSH), (2007, November 27). Provides training in Occupational Health Nursing.

 

Licensure

As all professional registered nurses, occupational health nurses are required to have a license from the state in which they practice nursing. States vary in their requirements and the responsibilities they grant for scope of nursing practice. See the board of nursing or the board of health professionals governing the practice of nursing in your state for further information.

• National Council of State Boards of Nursing, Inc. Contains information related to the licensure requirements of each state.

Certification

Reflects specialty practice and knowledge at a mastery level

 

Role of school nurse

Seven roles of the school nurse have evolved from this definition.

The school nurse provides direct health care to students and staff.

The school nurse provides care to students and staff who have been injured or who present with acute illnesses. Care may involve treatment of health problems within the scope of nursing practice, communication with parents for treatment, and referral to other providers. The school nurse uses the nursing process to assess, plan, implement, and evaluate care for students with chronic health conditions. This care should begin with the development of a nursing care plan (also known as an individualized health care plan) that should include an emergency action plan. The school nurse is responsible for medication administration and the performance of health care procedures that are within the scope of nursing practice and are ordered by an appropriately licensed health care provider. The school nurse also assists faculty and staff in monitoring chronic health conditions. As the scope of nursing practice expands to utilize the increasingly complex technology needed to provide up-to-date care for clients, the school nurse’s body of knowledge grows through personal professional development.

The school nurse provides leadership for the provision of health services.

In addition to providing health services directly, the school nurse must take into account the nature of the school environment, including available resources. As the health care expert within the school, the school nurse assesses the overall system of care and develops a plan for assuring that health needs are met. This leadership role includes developing a plan for responding to emergencies and disasters and training staff to respond appropriately. It also involves the appropriate delegation of care within applicable laws. Delegation to others involves initial assessment, training, competency validation, supervision, and evaluation by the school nurse.

The school nurse provides screening and referral for health conditions.

In order to address potential health problems that are barriers to learning or symptoms of underlying medical conditions, the school nurse often engages in screening activities. Screening activities may include vision, hearing, postural, body mass index, or other screening. Determination of which screenings should be performed is based on several factors, including legal obligations, the validity of the screening test, the cost-effectiveness of the screening program, and the availability of resources to assure referral and follow-up.

The school nurse promotes a healthy school environment.

The school nurse provides for the physical and emotional safety of the school community. The school nurse monitors immunizations, assures appropriate exclusion from and re-entry into school, and reports communicable diseases as required by law. The school nurse provides leadership to the school in implementing precautions for blood borne pathogens and other infectious diseases. The school nurse also assesses the physical environment of the school and takes actions to improve health and safety.  Such activities may include an assessment of the playground, indoor air quality evaluation, or a review of patterns of illness or injury to determine a source of concern. Additionally, the school nurse addresses the emotional environment of the school to decrease conditions that may lead to bullying and violence and/or an environment not conducive to optimal mental health and learning.

The school nurse promotes health.

The school nurse provides health education by providing health information directly to individual students, groups of students, or classes or by providing guidance about the health education curriculum, encouraging comprehensive, sequential, and age appropriate information. They may also provide programs to staff, families, and the community on health topics. Other health promotion activities may include health fairs for students, families, or staff, consultation with other school staff such as food service personnel or physical education teachers regarding healthy lifestyles, and staff wellness programs. The school nurse is a member of the coordinated school health team that promotes the health and well-being of school members through collaborative efforts.

The school nurse serves in a leadership role for health policies and programs.

As the health care expert within the school system, the school nurse takes a leadership role in the development and evaluation of school health policies. The school nurse participates in and provides leadership to coordinated school health programs, crises/disaster management teams, and school health advisory councils. The school nurse promotes nursing as a career by discussions with students as appropriate, role modeling, and serving as a preceptor for student nurses or as a mentor for others beginning school nursing practice. Additionally, the school nurse participates in measuring outcomes or research, as appropriate, to advance the profession and advocates for programs and policies that positively affect the health of students or impact the profession of school nursing.

The school nurse serves as a liaison between school personnel, family, community, and health care providers

The school nurse participates as the health expert on Individualized Education Plan and 504 teams and on student and family assistance teams. As case manager, the nurse communicates with the family through telephone calls, assures them with written communication and home visits as needed, and serves as a representative of the school community. The school nurse also communicates with community health providers and community health care agencies while ensuring appropriate confidentiality, develops community partnerships, and serves on community coalitions to promote the health of the community.

The school nurse may take on additional roles to meet the needs of the school community.

Conclusion

Healthy children are successful learners. The school nurse has a multi-faceted role within the school setting, one that supports the physical, mental, emotional, and social health of students and their success in the learning process.Role and Functions of the Community Health Nurse

Role and Functions of the Community Health Nurse

 

Role and Functions of the Community Health Nurse Community health nurses have always practiced in a wide variety of settings and assumed various roles. In this topic, the seven major roles and six of the most common settings for CHN practice are examined. The seven major roles are: clinician educator advocate manager collaborator leader researcher The role of the clinician or care provider is a familiar one for most people. In community health the clinician views clients in the context of larger systems. The family or group must be considered in totality. The community health nurse provides care along the entire range of the wellness-illness continuum; however, promotion of health and prevention of illness are emphasized. Skills in observation, listening, communication, counselling, and physical care are important for the community health nurse. Recent concerns for environment, sociocultural, psychological, and economic factors in community health have created a need for stronger skills in assessing the needs of populations at the community level. One of the major functions of the community health nurse is that of health educator. As educators, nurses seek to facilitate client learning on a broad range of topics. They may act as consultants to individuals or groups, hold formal classes, or share information informally with clients. Self-care concepts, techniques for preventing illness, and health promotion strategies are emphasized throughout the health teaching process. Two underlying goals in client advocacy are described. One goal of the community health nurse as advocate is to help clients find out what services are available, which ones they are entitled to, and how to obtain these services.  A second goal is to influence change and make the system more relevant and responsible to clients’ needs. Four characteristics required for successful advocacy are: assertiveness willingness to take risks good communication and negotiation skills ability to identify resources and obtain results The manager’s role is common to all nurses. Nurses serve as managers when they oversee client care, supervise ancillary staff, do case management, run clinics and conduct community health needs assessment projects. The nurse engages in four steps of the management process of planning, organizing, leading and controlling evaluation. Each of these functions is described in the text. Specific decision-making behaviors are part of the manager’s role as well as human, conceptual and technical skills.   Collaboration with clients, other nurses, physicians, social workers, physical therapists, nutritionists, attorneys, secretaries, and other colleagues is part of the role of the community health nurse. Collaboration is defined as working jointly with to hers in a common endeavor to cooperate as partners. Skills required for successful collaboration are:   ·        communication skills, ·        assertiveness, ·        Consultant skills.   The role of leader is distinguished from the role of manager. As a leader, the community health nurse directs, influences, or persuades others to effect change that will positively affect people’s health. Acting as a change agent and influencing health planning at the local, state and national levels are elements of the role of the leader.   In the role of researcher, community health nurses engage in systematic investigation, collection, and analysis of date to enhance community health practice. (The research process is discussed in Chapters 12 and 24.) Research in community health may range from simple inquiries to complex agency or organizational studies. Attributes of a nurse researcher include a questioning attitude, careful observation, open-mindedness, analytical skills, and tenacity.

 

 

 

 

 

Summary

 

Community health nursing involves; health promotion, health maintenance, health education, and management, coordination, and continuity of care and utilized in a holistic to the management of the health care of individuals.

 

 

 

References

 American Nurses’ Association. (2000). Public health nursing: A partner for healthy populations. Washington, D.C.: ANA.*

American Nurses’ Association. (1999). Scope and standards of home health nursing practice Washington, D.C.: ANA.*

American Nurses’ Association. (1999) Scope and standards of public health nursing practice. Washington, D.C.: ANA.*

American Nurses’ Association. (1998). Standards of clinical nursing practice, 2^nd ed Washington, D.C.:ANA.American Nurses’ Association. (1983). Standards of school nursing practice. Kansas  City, MO: ANA.*

Clark, M.J. (1999). Nursing in the community: Dimensions of community health nursing3^rd ed., Stamford, CT: Appleton & Lange

Dochterman, JM & Bulechek, GM. (2004). Nursing interventions classification, 4^th

ed St.

Louis: Mosby. *

Merson, M.H., Black, R.E., & Mills, A.J.,(Eds.) (2001) International public health:Diseases, programs, systems, and policies. Gaithersburg, MD: Aspen Publishers,  Inc.*

Wright L., & Leahey, M. (1994).  Nurses and families, 2nd Ed..  Philadelphia: F.A. Davis,Co.*

 

 

 

USEFUL LINKS:

 

 

·        HealthyPeople 2010:   http://www.healthypeople.gov/

·        Center for Disease Control and Prevention:  http://www.cdc.gov/

·        National Center for Health Statistics:  http://www.cdc.gov/nchs/

·        Florida Department of Health:  http://www.doh.state.fl.us/