Community Health Nursing
Community health nursing is a huge umbrella term with many different roles and specialties. Some specialties in community health include home health nursing, public health nursing, mental health nursing, occupational nursing, school nursing, and correctional nursing (works with inmates). Forensic nursing is a new category that works with emergency departments. Parish nurse works with the ministry, worshiping, and teaching. Telenurse provides nursing care through the use of a variety of technologies such as phone or skype.
Home Health Nursing
Home health nursing was created to provide care after being discharged from the hospital. The goals of home health nurses include health promotion, health maintenance, and health restoration. The main goal is rehabilitation and restoration to maximum health function. Nursing at home meets the basic needs of the client. These nurses work with family. The main focus is primary prevention, which is preventing disease and illness before they occur. Home health nursing connects the client and services to ensure continuity of care between the hospital and community. These community nurses prevent health problems from arising following discharge and prevent unnecessary hospital readmission.
The expansion of home health is due to numerous reasons. One reason is due to early discharges at hospitals. Hospitals try to get people back into the comfort of their own homes as quickly as possible. Some individuals actually prefer to be cared for at home. Technologies now allow for and make it easier for nursing to be done at home.
Elders are the most frequent users, but all ages can use this service. This way of nursing allows individuals to have control over and determine their own health needs.
There are direct and indirect functions of a nurse. Direct functions include physical care, supervision, assessing and teaching, and reporting to a physician. Indirect functions include consulting with others, advocating, documentation, and obtaining test results.
These nurses must be flexible, self-directed, adaptable, and great critical thinkers. When the nurse is unable to direct the client’s issue they direct the client through a referral process which will give the client another source of assistance.
Public Health Nurse
Public health nurses take a population approach to protect and promote health and prevent disease. This involves coordinating care, planning services or programs, and collaboration. The client may be the population, the community, a group, the family, or the individual. These nurses must have great communication skills. These nurses have many roles that depend on the needs and resources of the community. These roles include advocating for a required service, management, school health and safety, emergency nursing, and controlling communicable diseases.
Rural Nursing
Community Health Care Nursing is working in a rural setting. Rural is generally in terms of geographic location and population density or the distance from/time to commute to an urban center. Rural health care providers usually live and practice in a particular community for decades. There are a limited number of community nurses. CHN needs to have an accurate understanding of rural clients to design community health programs that are available accessible and appropriate.
People in rural areas may experience increased health risks such as obesity, higher smoke rates, higher prevalence of heart disease, higher mental illness rates, higher rates of hypertension, and arthritis.
There are many barriers to rural settings. Accessibility (lack of existing health care services and lack of the necessary personnel to provide those services). Affordability, services may not come at a reasonable cost, or family may have insufficient resources to purchase them when needed. Driving cost or low income, coverage for health care. Acceptability and service may be inappropriate or may not be offered in a manner that corresponds with the values of the target population, things will be done in the “hospital way”.
There are many challenges for nurses in rule settings. In small towns, everyone often knows everyone but yet boundaries must be kept. Information cannot be shared and must remain confidential. As a nurse in a small town, people may think you know a little about a lot. These nurses often have heavy workloads. Nurses must put parameters on work, prevent getting burnt out.
Practical Nurse
Practical nurses have countless roles. They must perform skills as set up by the agency, document care given, observing and report client changes to a supervisor, and call appropriate persons in emergency situations. They must also validate and evaluate services. Practical nurses assist with activities of daily living (ADLs), assist with transfers and bathing, provide nutritional counseling, exercise and mobility encouragement, as well as stress management. Skills of a practical nurse include ostomy care, dressing changes, medication administration, catheter insertion, pressure ulcer treatment, and much more.
Evidence-Informed Practice
The evidence-Informed practice provides guidance to nurses to help them make the most relevant and individualized nursing care decisions in their practice
Evidence-informed practice is combining the best evidence derived from research with clinical practice knowledge and expertise and unique client expectations preferences or choices when making clinical decisions. the application of the best available evidence to improve practice.
Community health care nurses use the evidence-informed practice to develop a hypothesis, make clinical observations, look at various sources for information, and develop clinical questions.
Clinical practice guidelines are developed by a team of experts who find and appraise the evidence draw conclusion and make recommendations about best practice.
When applying the evidence-informed practice to client community nurses must recognize the importance of assisting the client with decision making. They must ensure that the evidence is at an appropriate literacy level for each client. These nurses must advise the client of the benefits and risks of intervention and must always consider client preferences and values in practice decisions.
Ethics
Ethics is a branch of philosophy that includes a body of knowledge about the moral life and a process of reflection for determining what persons ought to do or be regarding this life. Culture will affect ethics. Community nurses’ ethical principles are doing good and preventing harm. An ethical dilemma is a puzzling moral issue in which a person takes or chooses not to take a course of action. Ethical decision making is the process of how ethical decisions are made. Ethical issues are moral challenges facing our profession.
Morals are shared generational societal norms about what constitutes right and wrong. Values are beliefs about shared worth or importance of what is desired or esteemed within society.
The code of ethics is a framework nurses use to guide their professional obligation and actions within the profession. The code of ethics includes safe, competent care, health and wellbeing, respect and autonomy, the dignity of all persons, justice and fairness to all, accountability, confidentiality, and qualitative practice.
Veracity is telling the truth, this promotes trust in a therapeutic relationship. There may be exceptions where telling the truth may bring about more harm than good. Ethical judgment chooses the best ethical resolution of the issue. The choice of action feels right for the resolution of an ethical issue. Consequentialism is when the action is the one that produces the greatest amount of good or the least amount of evil in a given situation. Utilitarianism maximizes the good and minimizes the harm for the greatest number of people. Deontology is when the action is right or wrong in itself regardless of the good that might come from it.
Virtue ethics are to enable persons to flourish as human beings for example compassion, trustworthiness, and integrity. Ethics of care is a belief in the morality of responsibility in relationships that emphasize connection and caring.
Advocacy
Advocacy is a nurse’s responsibility. It minimizes unnecessary or unwanted procedures that may increase suffering, protects the communities’ privacy, helps individuals gain access to appropriate health services, and ensures fairness in health.
Advocacy is an ethical concept in community nursing that we can differentiate between community health and public health. In terms of community health, the focus is on the individual and looks at the quality of life of the individual in the community. Public health advocacy deals with the group and looks at the quality of life for populations.
There are three stages for the framework of advocacy. The information stage gathers information. The strategy stage decides on a goal and how you will reach it. The action stage focuses on implementing the strategies.
To ensure client advocacy a nurse must maintain confidentiality, keep the client informed, act in accordance with the client’s wishes and instructions and always act in the client (individual, or groups) best interest.
Principles of Community Nurses
Respect for autonomy, dignity and respect for individuals, non-maleficence (do no harm), beneficence (do good), and fair distribution of benefits.
There are three theories of distributive rights egalitarianism, libertarianism, and liberal democratism. Egalitarian means that everyone is entitled to equal rights and equal treatment in society. Libertarian means we have the right to private property. Liberal democracy is a theory that values both liberty and equality.
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