Community health has become a critical part of overall public health policy and strategies. It is necessary to protect the safety of populations within communities through disease protection and health interventions. The impact that nurses carry on influencing both policy development and patient behavior provides a need for community health nurses in public and private health organizations.
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Role of a Community Health Nurse
Community health nurse is a term that has been interchangeably used with public health nurse, both suggesting population-oriented practice within community settings with the purpose of disease prevention and health promotion. These nurses are specially trained to work in public health settings and have skills to identify health issues and practice in a population-focused manner. Community health nurses are highly adaptable and able to provide comprehensive nursing care within non-traditional hospital settings, but rather local community locations which may require a specialist.
This type of nurse is most effective in working for public and government organizations, focusing on delivering care, and providing resources to those in need. Community nurses may attend to patients at home, organize public health interventions, and advocate for access to care. These nurses maintain a focus on client-centered care within any setting with a broad philosophy to attend to public health (Stanhope & Lancaster, 2015). They may be responsible for outreach and prevention of deadly diseases such as tuberculosis or HIV/AIDS in at-risk populations. Furthermore, community health nurses are responsible for emergency preparedness for disasters, including bioterrorism, which may impact the community.
Community health competence and practice involve developing relationships with community members and noticing patterns within the overall social aspects of the neighborhood. That often means assisting families within home settings or working with community resources to provide any necessary medical services. For example, if there is a noticeable pattern of children being left home alone or with elderly caretakers, a program may be established through local schools to aid in this aspect. Although not directly related to health, such interventions are critical for community health nurses to ensure public safety. Community-based nursing is centered on care. It requires knowledge about family dynamics as well as cultural diversity that impact community and familial structures.
A nurse-patient relationship is formed with the family as well to provide care for patients in a home setting. That may include a comprehensive plan that evaluates a patient’s lifestyle patterns. A plan attempts to create a routine for patients that can be supported with the help of family members in order to ensure improvement. Since public health nurses are aware of all available community health resources, including providers, pharmacies, and support groups, they can direct families to receive necessary support in order to provide for patient needs. Overall, community health nurses work with patients and families to “assume responsibility for health care decisions” through the process of “planning, implementation, and evaluation of health care approaches” (Potter, Perry, Stockert & Hall, 2016, p. 43).
Initiating and providing at-home care for patients is wrought with technical, financial, and practical challenges. With the extended life-span, the rise of chronic and multi-morbidity illnesses, and increasing costs of hospitalization, at-home care may be an appealing resource in communities for non-critical patients. A common barrier is based on simple logistics since providers are unable to plan and coordinate at-home care efficiently (resulting in decreased quality of care) due to limited resources and lack of communication methods.
They are unable to access critical data on a patient’s status, care plans, and diagnostic test results since electronic health records are rarely available from non-hospital infrastructure (Sockolow, Zakeri, & Bowles, 2014). As a result, competent health care delivery and decision-making that leads to positive outcomes are not as efficient.
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Initiating home care services is bound to constraints within the regulatory and financial mechanisms. Current systems of Medicare and insurance do not support at-home care, and any existing systems do not include reimbursements for the information technology, travel, care transition, and staffing for such purposes (Landers et al., 2016).
Stakeholders are also concerned about the regulation of home-provided care services as new policies would have to be developed to establish eligibility, quality of services, and provider coordination. Furthermore, it would be necessary to ensure integrity and provide incidences of fraud and abuse by new entrants to the market if community-based care was to expand. Regarding quality and patient experience, new contexts and indicators have to be developed to protect patients and ensure the best quality of care (Landers et al., 2016).
Home health care delivery for patients differs based on geographical location as urban and rural areas can result in differing patient needs and viability of providing such care. For example, rural patients are often more severely ill, with risk factors for hospitalization, most often due to lack of participation in health promotions. Characteristics of rural households result in challenges to home health care access, which is difficult to attain as it is.
Geographical location leads to isolation and results in increased transportation and payroll costs. Other factors include lower income and educational attainment in rural areas than urban populations. Rural elderly are less likely to have private health insurance which is more open to at-home care rather than standard Medicaid. Urban households have a wide availability of services which can support a homebound patient which leads to the inclusion of health care as part of the basic needs (University of Washington School of Medicine, 2016).
Landers, S., Madigan, E., Leff, B., Rosati, R. J., McCann, B. A., Hornbake, R., … Breese, E. (2016). The future of home health care. Home Health Care Management & Practice, 28(4), 262-278. Web.
Potter, P.A., Perry, A.G., Stockert, P., & Hall, A. (2016). Fundamentals of nursing (9th ed.). St. Louis, MO: Elsevier Health Sciences.
Sockolow, P., Zakeri, I., & Bowles, K. H. (2014). Barriers and facilitators to implementation and adoption of EHR in home care. Web.
Stanhope, M., & Lancaster, J. (2016). Public health nursing – e-book: Population-centered health care in the community (9th ed.). St. Louis, MO: Elsevier Health Sciences.
University of Washington School of Medicine. (2016). Access to rural home health services: Views from the field. Web.