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• All nurses should have a fundamental knowledge & skills that enhance community practice, as community employment opportunities for nursing are growing rapidly.
• Community is defined as the emerging interactions among a group of people who share common bonds & a common physical environment (where the client lives, works & plays)
• Community-based nursing takes place within this defined community in a specific practice setting. It appears unstructured but it is not.

• Almost every established community institution in someway is involved in the delivery of health care services (businesses, schools, churches, prisons & civic centers for example).
• Health care services are offered at grocery stores, shopping malls, county fairs & sports venues.
• Health care settings are organized by :
• Type of care provided (preventive, acute, chronic)
• Place care is provided (home, residence, church, school, camp)
• Who directs/provides the care (doctor, government, HMO, Nurse)
• Age group receiving care (infant, children, teens, elderly)
• Gender of client receiving care (female, male)
• High-risk client group (substance abuse, battered women, diseases, disabled, terminally ill, homeless).

• Preventive Care – Is designed to prevent or minimize disease or injury. Weight loss clinics, smoking cessation clinics, health & fitness clubs and nutrition centers are examples of this type of care. Nurses often teach & counsel in these setting.
• Acute Care – Is short-term care for the person with an episodic illness. Needs that were once cared for in the hospital are now cared for here. Examples are day surgery/diagnosis centers, and emergency care centers. They are cost effective. Technology & newer anesthesia also make for less invasive surgery as well as shorter recovery times. This setting developed from client overload in hospital Ers, which need to be reserved for serious acute care threats/needs. Nurses in this setting provide care, teach & case manage. Nurses are the primary link for access & referral to other services.
• Chronic Care – Provides post-acute, long-term chronic mental or physical disease care, or assists to enhance living skills for the chronically disabled. Subacute centers are the latest of this type of settings. Subacute facilitites provide a link between a client’s discharge from the acute care hospital & the return home. They offer this care at half the cost of the same care provided in a hospital because the degree of technology & specialized skills required for this care is lower.

• Home - It is projected that by the year 2010, 70% of all nursing care will take place in the home. Home care nurses provide care to homebound clients with acute or chronic health care problems. Home health care is the oldest form of health care services. The goal of home care is to return clients to their highest level of functioning and to prevent or delay progressive disorders.
• Residential Care – Provides for the basic human needs of shelter, food and water, and a sense of safety and security, and a supportive environment in which to manage health care needs. It may be short-term or long-term and depends on the purpose for the facility placement. The focus and roles of the caregiver are largely dictated by the setting. Nurse-client interactions should encourage the client’s sense of control and independence in decision making. Client advocacy is crucial. Approaches of care include assisted living centers, substance abuse treatment centers, group homes, and halfway houses. Assisted living centers are often set up in apartment complexes. Residents share an apartment with 1 to 3 other people. This helps to foster a greater sense of freedom, privacy, and independence. Services that meet resident needs for structure, supervision, education and health care are housed in accessible areas of the apartment complex. Enhancing ADLs if often the focus, which may include providing meals, housekeeping, shopping, recreation, transportation and vocational opportunities.
• Parish/Church – Parish nursing dates back to the first century of Christendom. Early churches assumed a large responsibility for health care of their members. Recently, there has been a resurgence in church-based health care ministry. Churches are offering a variety of health care services to their members and other individuals in the community to supplement health care offerings. Nurses are often instrumental in organizing and sustaining such offerings, helping shape the vision of what services are needed, recruiting, training and mobilizing volunteers. Examples of services offered include respite care, parenting programs, immunization drives and health screening activities. And as always role of the advocate.
• Schools – Offer a major practice setting for nurses. Educational requirements range from an associate to a master’s degree. School nurses are often the primary source for health assessment, maintenance and education; and first line of emergency care for children. They develop programs to promote wellness and discourage high-risk behaviors and in turn meet the needs of developing children and young adults.
• Work Sites – Health leads to enhanced productivity and reduced labor costs, therefor some businesses offer programs and services designed to prevent or manage work related injury, maintain wellness & promote healthy lifestyles. Target topics include job safety, nutrition, stress reduction, alcohol & drug abuse, weight reduction, smoking cessation & exercise, and clinics to manage minor illness & injury. The goal is a healthy & productive company and staff.

• Camps – Individuals at camp may be healthy or may have special health care needs as a result of disease or multiple disabilities. There are many types of camps. There are camps for people with vision, hearing & mobility problems, diabetes, cerebral palsy, muscular dystrophy, cancer, asthma, obesity, special interests, and church, scouting and YMCA/YWCA to name a few. Nurses typically provide campers with direct care for acute situations, first aid and health education. In the case where there is chronic illness, the nurse directs their daily health care regimens (from ensuring that prescribed medication schedules are met to the administration of chemotherapy, depending on camp setting).

• Mobile Health Centers – Provide accessible, affordable health care services to people not serve by more traditional settings. Examples include rural areas, the homeless & migrant farm workers. Mobile units provide health maintenance, screening, care of acute/chronic ailments, case management & referral. The purpose is to improve access and improve health status. Many of these services are free or at low cost, so funding is a priority. Funding sources include public, private, donation, reimbursement and federal aid. Advanced practice nurses often direct and supervise mobile units.

• Sites for Battered Women – Hotlines and shelters offer a first line of defense for immediate safety. Halfway houses offer food, shelter, clothing, health care, and counseling to vocational training and job placement services.
• Mental Health Centers – Have a mandate from the federal government to offer outpatient services, emergency services, consultation, and educational programs. They are also mandated to provide inpatient services for clients in a crisis. The purposes of these centers are to promote mental health services on a local level with the involvement of clients as well as service providers.
• Substance Abuse Treatment Centers – The use of legal and illegal substances is on the increase, as is addiction and the need for treatment. These centers may be in residential or ambulatory care settings and provide withdrawal, treatment and counseling services. Sobriety is the overall goal of any substance abuse program and is a lifelong, day-to-day process.
• Missions and Shelters – Provide food, housing, and safety services to the homeless, as well as counseling, health care, spiritual guidance, and substance abuse treatment programs. Some provide cots for overnight stay, the supply is often limited and admission is based on a first-come, first-serve basis. People who frequent shelters are usually homeless and have little material or personal resources. They lack health care & are at high risk for a variety of diseases/ailments due to their living environment. Local hospitals & clinics usually donate needed supplies. Basic medications, clothing, shoes & other supplies are given free of charge to the clients. The nurse working here may be the only heath care provider that client will see.
• Hospice – Provides treatment for the terminally ill client with emphasis on palliative care rather than curative care. The goals are to free the client of pain & symptoms, provide in-home care and spiritual support to the dying individual and the immediate family. The hospice client is cared for by an interdisciplinary team that include doctors, social workers, pharmacists, nutritionists and bereavement counselors. Hospice nurses have special training in pain management, and death & dying.

• Ambulatory Care – deliver care on an outpatient basis, such as public health clinics, a doctor’s office, private clinic, and clinic run by HMOs (which are on the rise). Newer community offerings include the nursing center, managed and run by nurses. They frequently offer health care services to a specific population such as the elderly, students or the homeless.
• Nursing centers are the focus of Community Nursing Organizations, which is a new 3-year government-financed national nursing demonstration project based on the nurse-run center concept. The goal is to create and test a nurse-managed model of community-based ambulatory care will providing appropriate support and services for Medicare clients. The services of CNO are designed to meet identified standards of quality and provide cost-effective care with a focus on health promotion & illness prevention. There are fixed fees but the CNO has the authority to b flexible. For the first time, a federally funded program is encouraging nurses to use a wide range of autonomy in the delivery of care while providing financial support for that care. J
• Respite Centers – The rapid growth of care at home is expected to continue. Respite care is given to a client by an outside person or agency on a temporary basis in order to relieve an unpaid caregiver living in the client’s home. Respite care is essential in maintaining the health of the caregiver. Respite centers use adult day care or short-term convalescent stays for the ill or disabled client to give caregivers the personal and social time needed to restore their emotional and physical energy. Funding comes from personal finances, insurance plans, and federal & state.

Study exercise. Can you define the following terms?

Acute care

Adult day care

Advanced practice nurse

Ambulatory care

Assisted living

Chronic care

Hospice

Nursing centers

Palliative care

Preventive care

Respite care

Setting

Structured health care setting

See page 15-16 or a dictionary for assistance.