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COMMUNITY HEALTH . ROXANNE RIEDY MSN MARILEE ELIAS MSN, CNE. 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.

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community health

COMMUNITY HEALTH

ROXANNE RIEDY MSN

MARILEE ELIAS MSN, CNE

community
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
Population
  • All the individuals inhabiting a specific area
  • Leesburg, FL 20,796 (2012 Estimate)
  • Clermont, FL 29,421 (2012 Estimate)

(www.census.gov )

aggregate
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
Community Components
  • Structure
  • Status
  • Process
community components1
Community Components

Structure: general characteristics of a community, includes:

  • Demographic data
  • Data about healthcare services
community components2
Community Components

Status: describes the outcome components of the community

  • Biological Outcome Components
  • Emotional Outcome Components
  • Social Outcome Components
community components3
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
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
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 20201
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
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
Each Community also has Vulnerable Populations
  • Aggregate with increase risks for:
    • Developing illness
    • Adverse health outcomes
vulnerable populations
Vulnerable Populations

Vulnerability Factors:

  • Limited economic resources
  • Limited social resources
  • Age
  • Chronic disease
  • History of abuse or trauma
federal poverty levels
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

( www.ASPE.hhs.gov , 2014)

community nursing
Community Nursing
  • A Community is:
    • A site for Healthcare Delivery
    • A recipient of Healthcare Services
community based care
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 care1
Community Based Care

Three approaches

  • Community health nursing
  • Public health nursing
  • Community oriented nursing
community based care2
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 care3
Community Based Care

Public 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 care4
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
pioneers of community nursing
Pioneers of Community Nursing
  • Florence Nightingale
  • Lillian Wald
  • Clara Barton
  • Margaret Sanger
community nursing1
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
roles of community health nurse
Roles of Community Health Nurse
  • Client advocate
  • Educator
  • Collaborator
  • Counselor
  • Case Manager
community nursing intervention classification
Community Nursing Intervention Classification
  • Primary (first-level)
  • Secondary (second-level)
  • Tertiary (third-level)
community based careers
Community Based Careers
  • School nurse
  • Occupational health
  • Parish nursing
  • Correctional nursing
  • Public health
  • Disaster services
  • International
geopolitical community assessment
Geopolitical Community Assessment
  • Windshield survey
  • Databases
  • Client perceptions
nursing diagnosis
Nursing Diagnosis
  • Analyze the information, develop a list of the communities strengths and limitations
  • Prioritize the information
  • Create a community based diagnosis
home health
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 ( www.nahc.org, 2012)
  • 2014 projected costs over $86 billion

(www.cms.gov, 2014)

home health care recipients
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
How do our clients get referred to home healthcare?
  • Hospital-based Referrals
  • Other Community Sources of Referrals
  • Reimbursement Evaluation
goal of home health care
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 care
Home Health Care
  • Advantages
  • Disadvantages
home health agencies
Home Health Agencies
  • Direct care agencies
  • Indirect service agencies
  • Types of agencies

Public

Voluntary

Proprietary

Hospital-based

home health team
Home Health Team
  • RN is coordinator of health services
  • Multidisciplinary Team based on patients needs
roles of home health nurse
Roles of Home Health Nurse
  • Direct care provider
  • Client /family educator
  • Client advocate
  • Care Coordinator
hospice nurse
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
reimbursement
Reimbursement
  • Medicare
  • Medicaid
  • Private insurance company
  • Patient Self-Pay
medicare
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
Medicaid
  • Individuals with limited financial resources
  • Sponsored by federal government and each state
  • Payer for Home and Hospice Care
private insurance
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
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
Home Visit

Three phases

  • Preparation prior to the visit
  • Nursing care provided during the visit
  • Evaluation after the visit is completed
home visit1
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 visit2
Home Visit

During 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
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
home visit3
Home Visit

After the visit:

  • Safety (again)
  • Proceed to safe area PRN & then
  • Complete necessary documentation