1. 1. Identify factors contributing to the shift of health care from the hospital to the home and community.
    • a. Several factors have contributed to this trend, among them rising health care cost, an aging population, and a growing emphasis on managing chronic illness and stress, prevention
    • b. ng illness, and enhancing quality of life.
    • 2. What are the goals of home and community nursing practice?
    • a. The goals of home and community nursing practice are health promotion, disease prevention, health maintenance, and health restoration
    • b. Increasing access to preventive health services is a goal of Healthy People 2010. This goal can best be achieved by delivering services where people live, work, play, or attended school, in their homes and communities.
    • c. For the home and community-based nurse, nursing care generally focuses on the individual client and the persons who provide support for that client
    • d. Community health nursing focuses on local, state, federal, and international health initiatives. For the community health nurse, there are three general types of clients: individuals, families, and groups. Groups may be communities, at-risk aggregates, or persons with similar problems and needs
    • e. Home health nursing practice and community-based nursing practice differ from nursing in acute-care settings in many ways.
  2. 3. Define home health nursing. What are the factors that contributed to the growth of home health care in the 1980s and 90s? Discuss advantages and disadvantages of home health care versus hospital based care. How is home health care paid for?
    • a. Home health services center on individualized, episodic care with curative, short-term outcomes. Many home health care nurses are generalists or specialists possessing high-technology skills that were formerly used only in acute-care setting.
    • b. The factors that contributed to the growth of home health care in the 1980s and 90s these factors include
    • i. The increase in the older population, who are frequent recipients of health care
    • ii. Third-party payer who favor home care to control costs
    • iii. The ability of agencies and institutions to successfully deliver high-technology services in the home
    • iv. Consumers who prefer to receive care in the home rather than an institution.
    • c. Advantages
    • i. Convenience
    • ii. Access
    • iii. Information
    • iv. Relationship
    • v. Cost
    • vi. Outcomes
    • d. Disadvantages
    • i. Nurses having firsthand knowledge and experience about the burden of care giving
    • ii. Cutting health care cost
    • iii. Placing the caregivers themselves at risk for physiologic and psychosocial problems
  3. 4. Discuss differences between home health nursing and hospital nursing.
    • a. The nurse works within the client’s environment. The nurse is a guest in the client’s house. In the hospital, there is often the feeling that the nurses and doctors own the hospital and the client is a guest.
    • b. The need for clear and complete communication is essential because other health team members are usually not present with the nurse.
    • c. Knowledge of reimbursement systems is essential. Clients must know what services are available, because most people do not pay directly for services.
    • d. The home health nurse works alone. The hospital nurse is surrounded by other colleagues, whereas the home health nurse had only a telephone
    • e. The nurse in the hospital setting has a large variety of supplies and equipment. The home health nurse often must create or adapt equipment to fit the home.
    • f. Knowledge of community resources is important. Community resources can often bring a great deal of improvement to the client’s quality of life. Home health nurses should have a resource file to share with the client and the client’s family.
  4. 5. Describe how the application of the nursing process is done in home health nursing.
    • a. Accessing – Nurses must assess the health care needs of the clients and family in the context of the home and community environment
    • b. Diagnosing – nursing diagnoses specific to the client’s health needs, nursing diagnoses related to the home environment may be identified
    • c. Planning and intervention – Planning and intervention, done in collaboration with the client and caregivers, focuses on establishing a realistic plan for home health management, teaching the client and family the techniques of home care, and identifying appropriate resources to assist the client and family in maintain self-sufficiency
    • d. Evaluating – Evaluation can be done by the nurse on subsequent home visits by observing the same parameters assessed on the initial home visit. Also teaching caregivers parameters of evaluation so that they can obtain professional intervention if needed.
  5. 6. What is the goal and focus of community nursing? Identify 10 characteristics of a healthy community.
    • a. The goals and focus of community nursing is nursing services to the population as a whole, providing care for individuals, families, and groups in the community enhances the health of the community as a whole.
    • b. Ten characteristics of a healthy community
    • i. A healthy community:
    • 1. Is one in which members have a high degree of awareness that “we are a community”.
    • 2. Uses its natural resources wisely while taking steps to conserve them for future generations
    • 3. Openly recognizes the existence of subgroups and welcomes their participation in community affairs
    • 4. Is prepared to meet crises
    • 5. Is a problem-solving community; it identifies, analyzes, and organizes to meet its own needs
    • 6. Posses open channels of communications that allow information to flow among all subgroups of citizens in all directions
    • 7. Seeks to make each of its systems’ resources available to all members of the community
    • 8. Has legitimate and effective ways to settle disputes that arise within the community
    • 9. Encourages maximum citizens participation in decision making
    • 10. Promotes a high level of wellness among all its members.
  6. 7. Describe settings for community based nursing.
    • a. Community health nursing
    • i. Is a field of nursing that has specialized knowledge and skills and focuses on a particular group of people receiving its services
    • ii. Combines public health science with nursing science
    • iii. Is population focused
    • iv. Emphasizes prevention, health promotions, and wellness
    • v. Promotes client responsibility and self-care
    • vi. Uses aggregate management and analysis
    • vii. Uses principles of organizational theory
    • viii. Involves inter-professional collaboration
  7. 8. What is the difference between community based nursing and community health nursing? What are the major assumptions in the goal that “the community health nurse is to promote health and prevent illness in populations?
  8. 9. What are the goals of Healthy People 2010?
    • a. Goal 1: Increase Quality and Years of Healthy Life
    • i. The first goal of Healthy People 2010 is to help individuals of all ages increase life expectancy and improve their quality of life.
    • b. Goal 2: Eliminate Health Disparities
    • i. The second goal of Healthy People 2010 is to eliminate health disparities among different segments of the population.
    • ii. Each of the 28 focus area chapters also contains a concise goal statement. This statement frames the overall purpose of the focus area.
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