NUR1010 chapter11 practice settings and. specialties

  1. Expanded growth rates for nursing positions regarding specialized areas
    • Increase of 22% by 2018
    • Physician offices +48%
    • Home health + 33 %
    • Long term care facilities + 25%
    • Also inspected is an increase in nurses working in  
    • Nursing-based clinic practice
    • HMO's
    • Federal agencies
    • Health planning agencies
    • jails
    • insurances
    • Pharmaceutical and medical equipment companies
  2. Hospital care
    • Remain major site in which nurses practice (little more than half)
    • Bedside care through performing delegated medical functions
    • Identifying collaborative problems
    • Utilizing independent nursing diagnosis
    • supervise LPN's and other nursing assistants
    • Large hospital-> more specialized
    • Preliminary teaching of clients for procedures to be done at home
    • Provide information about resources in the community
  3. Why is acute care nursing community based  nursing?
    Because acute care nurses do take care of individuals and families in a specific community
  4. Care in the home: the home visiting nurse
    • Since middle of 19th community based (occupational, maternal and child nurse)
    • Major today is. Maternal/child care -> welfare promoted)
    •  and home health care
    • Studies prove benefit for maternal/child and at risk infants, risk pregnancies, lower rates of child abuse/neglect->less arrests...
  5. Why did the number of home visiting nurses decrease ? What was/is the result?
    • Because of lack of funding
    • ->dramatic reduction of health services for. low-income women
  6. The affordable care act of 2010 shows which position regarding home visiting services ?
    (same opinion WHO)
    • -> allocation of increase of home visiting services
    • -> lowers costs, incidents...
    • -> trusting relationship to nurse is important
    • ->enhances continuity of care for all
  7. Home care nursing/ home health care
    • Growing area for last 3 decades
    • Mainly through home visits
    • Most common with patients recently hospitalized, chronic ill, elderly
    • Agencies contract with insurance, client, medicare
  8. Living at home network/ Block nurse program
    • Community based service with professionals and volunteers for neighborhood services
    • Information, social and support services, skilled nursing care, other services for elderly
    • -> promote self-sufficiency
    • -> avoid nursing home placement
    • E.g. organizing yard work, food, shopping,...
    • -> this program was developed by nurses in 1982
    • -> depends on active commitment of schools, churches, colleges, businesses
    • $3 saved for each $1 spend keeping elderly at home
    • Skilled nursing, case management, supervision of aides (often nursing students)
  9. Adult Day Care Centers/ Adult Foster Care
    • Social, recreational, therapeutic activities for seniors, who are in need of supervision during the day.
    • Health assessment,
    • design and management of therapeutic regimens and medications
    • Bathing, and other physical care, personal attention, quiet atmosphere
  10. Who pays for Day Care Centers ?
    Adult foster Care Homes (AFCH's)
    /board and care homes
    /family care homes
    • Medicare does not always cover day care costs
    • -can pay with patient with Alzheimer, medical model, patient qualifies financially
    • Some facilities need based scholarships available
    • Private insurance sometimes covers portions if licensed Personnel involved
    • AoA provides funding for both day care and foster home
  11. Advantages of AFCH's
    • safe
    • small
    • Provides housing and protective oversight
    • For frail elderly/ with dementia
    • Optional elements of state Medicaid program (state decides which services are covered, who is eligible...)
    • locate through eldercare locator
  12. Parish nursing
    • Health promotion and disease prevention based on the care of the whole person (7 functions)
    • 1 faith
    • 2 health educator
    • 3 health counselor
    • 4 referral agent,
    • 5 trainer of volunteers
    • 6 health advocate
  13. History and facts about parish nursing
    • Nurses or volunteers,
    • Historical roots around 1800
    • 70% of parish nurses >55 years of age
    • screening
    • Health education
    • resource and referral services,
    • counseling
    • consultation
    • outreach
    • Addressing health care inequities by working with underserved  populations
    • Reach out for vulnerable populations like elderly, single parents, grieving individuals ...,
    • -> client empowerment, promoting self-care, self-advocacy,
  14. Residential care for elderly
    • Some elderly, often with chronic illnesses, might be lonely living by themselves-> living in residential center a better option
    • Successful placement -> research, family involvement, planning, focus on maintaining clients own control,
    • -> multiple levels of residential living
    • Client wants to keep control
    • Nurse must be familiar with clients health problems and needs
    • Being aware of physical, emotional, social, spiritual needs and their interrelation
    •  (important to any client!)
    • Advantage: captive audience
    • Health teaching and promotion, disease prevention,
    • Trust-> become counselor, advocate, direct support
  15. Retirement communities
    • Client functionally and socially independent
    • Live with other seniors
    • Accommodations include home with supportive services provided by community
  16. Assisted living facilities
    • For individual who needs some assistance in daily activities (bathing, dressing,...)
    • Functionally fairly independent
    • Bedrooms in homelike environment
  17. Extended care facilities / nursing homes
    • More institutional design
    • Ongoing medical and nursing services and supervision
    • For clients who need ongoing daily care for the rest of their lives
  18. Skilled nursing facilities
    • Provide nursing, medical, therapy services for elderly requiring ongoing medical or rehabilitative services but no hospitalization
    • Most are then discharged home or to extended care facility after an acute illness or accident or chronic condition
  19. What does research say regarding nurse staffing levels and client outcomes?
    • Research more than 2 decades:
    • low nurse staffing level -> lower client outcome
    • Increased direct care by RN's improves outcome for nursing home residents-> fewer: pressure ulcers, hospitalizations, urinary tract infections, weight loss, catheterization, increased use of nutritional supplements
  20. How can nursing quality also be improved?
    • Better working conditions:
    • Fair managerial procedures
    • Less time pressure
    • Engagement of staff in decision making
    • High nurse-patient ratios
    • resident/RN ratio important
  21. subacute rehabilitation centers
    • Focused on rehabilitation of client (illness, injury)
    • Provide longer term rehabilitative services (nursing, medical care, physical, occupational, speech therapy)
    • Length of stay limited
    • Discharged when goal reached or no progress
  22. Boarding Care Homes
    • Personal custodial care for clients who cannot live independently.
    • Do not have nursing or medical supervision/care.
    • Clients usually stay indefinitely
  23. Residential care across the lifespan
    • Chemical dependency treatment
    • Mentally ill
    • Developmentally delayed
    • Recovery from addiction
    • detoxification
    • Shelters for battered
    • Hospices for terminally ill...
    • Roles may include
    • Direct caregiver, case manager, health educator, discharge planner, counselor, collaborator, consultant, advocate.
  24. Shelters for partner violence
    • Happens across all social, economic, racial, ethnic boundaries
    • Most are women, but also men
    • Housing for victims and their children-> safe place with easy access to counseling
    • Nurse as:
    • Advocate, case manager, health educator, collaborator,-> often group meetings (good communicator needed)
    • Ask: "do you feel safe at home?" + able to provide resources for obtaining help
  25. Homeless shelters and transitional housing
    • Growing percentage of homeless since 1970
    • Increase in the number of families (recession, unemployment, rising foreclosures)
    • -> most are single parent women with up to 3 children, primarily preschoolers
    • ->urgent need for transitional housing to facilitate from crisis housing in homeless shelters to permanent stable housing
    • -> homeless -> poor health: 3-6 time higher illness rate, substantial unmet health care needs (dental, eyeglasses, surgery, mental care, meds,...), drug addiction, poor nutrition and hygiene, overcrowded facilities
    • -> higher illness rate with limited access to health care
    • -> urgent need for preventive approaches
    • Services: direct care, teaching, screening, assessing and completing immunization status, development of children,
    • Assist clients to follow up with existing health issues = tertiary prevention
    • Important role as advocates
  26. camps
    • Camps for children with chronic illnesses,
    • Reg. private or church camps
    • E.g. educational asthma camp (education, social, emotional advantages...)
  27. Rehabilitation centers
    • drug dependency treatment
    • goal: help clients reach optimal health
    • -> become part of productive community again
    • Direct care, teaching, counseling
  28. Detoxification facilities
    • Detoxifying the body from chemicals
    • Medication administration
    • Ongoing monitoring
    • Ensure client's safety
    • Health assessment
    • Identify immediate physical needs
    • Referral at time of discharge
  29. Treatment facilities for addictions
    • Usually do not require close monitoring
    • begin own recovery process
    • Recovery is a lifelong commitment
    • Focus is on success reentry of client into society
  30. Ambulatory care/ outpatient services
    • Clients who do not need inpatient care
    • Rapidly expanding
    • Provided by private and public hospitals
    • HMO's, physicians offices, community agencies, public health departments,
    • Medical care, surgery, diagnostic test, administration of medication, physical therapy, kidney dialysis,...
    • Located around community for ease of access
    • In some locations nurse practitioners have established their own ambulatory service
  31. Physicians offices
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NUR1010 chapter11 practice settings and. specialties
Practice settings, facilities, opportunities for nurses