1. Chapter 2 Community-BasedNursing PracticeCopyright 2010 Wolters Kluwer Health | Lippincott Williams & Wilkins

2. Factors that Have Increased the Need forCommunity Health Care Changes in federal legislation Tighter insurance regulations Decreasing health revenues Alternative health care delivery systems Copyright 2010 Wolters Kluwer Health | Lippincott Williams & Wilkins 3. Primary Concepts of Community-BasedCare Promotion of self-care Preventive care within content of community, culture Continuity of care CollaborationCopyright 2010 Wolters Kluwer Health | Lippincott Williams & Wilkins 4. Question The shift in health care delivery from acute care tocommunity based case is primarily the result ofA.alternative health care delivery systems.B.insurance regulations changes.C.federal legislation changes.D.combination of these three items. Copyright 2010 Wolters Kluwer Health | Lippincott Williams & Wilkins 5. Answer D. Combination of alternative health care deliverysystems, insurance regulations changes, federallegislation changes Rationale: Changes in federal legislation, tighterinsurance regulations, decreasing hospital revenues, andalternative health care delivery systems all have affectedthe ways in which health care is delivered. Copyright 2010 Wolters Kluwer Health | Lippincott Williams & Wilkins 6. Levels of Preventive Care Primary Secondary TertiaryCopyright 2010 Wolters Kluwer Health | Lippincott Williams & Wilkins 7. Community Health Settings Public health departments Various clinics Industrial, occupational nursing School nursing Home health careCopyright 2010 Wolters Kluwer Health | Lippincott Williams & Wilkins 8. Home Health Care Becoming one of largest areas of practice for nurses Collaborative, interdisciplinary HolisticCopyright 2010 Wolters Kluwer Health | Lippincott Williams & Wilkins 9. Community Nursing Differs from Hospital-Based Nursing Community nurses care for individuals, families, groupsoutside hospital setting Nurse is guest coming into patient home or communitysetting Nurse may provide Direct care Resources or advocacy to larger group in community setting Copyright 2010 Wolters Kluwer Health | Lippincott Williams & Wilkins 10. Community Nursing Nurses have little control over care environment Little on-site support or supervision available Supplies, resources may not be available Copyright 2010 Wolters Kluwer Health | Lippincott Williams & Wilkins 11. Nurses Functioning in the CommunityMust Be Self-directed Flexible Critical thinkers Independent decision makers Culturally competent Copyright 2010 Wolters Kluwer Health | Lippincott Williams & Wilkins 12. Nurses Functioning in the CommunityMust (contd) Have Basic nursing care competencies Excellent assessment skills Good abilities to provide health education Copyright 2010 Wolters Kluwer Health | Lippincott Williams & Wilkins 13. Question Tell whether the following statement is true or false: A common element of a nurse working in community-based case is the focus on the needs of the individual. Copyright 2010 Wolters Kluwer Health | Lippincott Williams & Wilkins 14. Answer False. Rationale: A common element in all the roles of the nurseworking in community-based care is the focus uponcommunity needs as well as the needs of the individualor the family. Copyright 2010 Wolters Kluwer Health | Lippincott Williams & Wilkins 15. Discharge Planning Transition from acute care to home care Collaborative Required for reimbursement by MedicareCopyright 2010 Wolters Kluwer Health | Lippincott Williams & Wilkins 16. Identifying Resources and MakingReferrals Directories Phone book Interdisciplinary collaborationCopyright 2010 Wolters Kluwer Health | Lippincott Williams & Wilkins 17. The Home Health Visit: Preparation Review agency policies, procedures Review referral forms, other appropriate records Discharge plan of care Call, arrange appointment Always ask permission, explain purpose, goals to patient Copyright 2010 Wolters Kluwer Health | Lippincott Williams & Wilkins 18. Assessing the Need for Home Visitss Current health status Home environment Level of self-care ability Level of nursing care needed Prognosis Educational needs Mental status Level of adherenceCopyright 2010 Wolters Kluwer Health | Lippincott Williams & Wilkins 19. Conducting the Home Health Visit Personal safety precautions Initial home visit Determining need for future visits Ending visit Copyright 2010 Wolters Kluwer Health | Lippincott Williams & Wilkins 20. Community Based Health Care Settings Ambulatory settings Occupational health programs School health programs Community nursemanaged centers Care for homelessCopyright 2010 Wolters Kluwer Health | Lippincott Williams & Wilkins 21. Question Tell whether the following statement is true or false: During the initial home visit, the patient is evaluated anda plan of care is established. Copyright 2010 Wolters Kluwer Health | Lippincott Williams & Wilkins 22. Answer True. Rationale: During the initial home visit, the patient isevaluated and a plan of care is established. The initialassessment includes evaluating the patient, the homeenvironment, the patients self-care abilities or thefamilys ability to provide care, and the patients need foradditional resources.Copyright 2010 Wolters Kluwer Health | Lippincott Williams & Wilkins