Community-Based Nursing Practice

A home care nurse is approached by the client's neighbor while walking to the car after visiting the client. The neighbor asks, "What's wrong with Tom? Is he sick?" How should the nurse respond?

"I'm a nurse caring for Tom, but I cannot tell you anything about his condition." Explanation: Friends, neighbors, or family members may ask the nurse about the client's condition. The nurse must remember that the client has a right to confidentiality, and information should only be shared with the client's consent. The nurse should tell the neighbor that the nurse cannot say anything about the client's condition. Asking the neighbor for to call the nurse or to ask the client's wife are not the correct responses.

A client is admitted to an acute care facility after having a stroke. The client will require a variety of healthcare services throughout the hospital stay as well as coordination of care prior to discharge. What referral would be a priority for overseeing the client's care

Case management Explanation: The person responsible for overseeing the client's care, usually an RN with a bachelor's or master's degree or another highly experienced health professional, is called the case manager. Physical therapy, occupational therapy, and dietary services are all important care disciplines but do not encompass all of the client's needs.

The home health nurse and the parish nurse have separate roles in health care. What best describes the common factor all community-based nurses share?

Community health nurses focus on community needs as well as the needs of individual patients. Explanation: Community health nurses have many roles, including epidemiologist, case manager, coordinator of services provided to a group of patients, occupational health nurse, school nurse, visiting nurse, hospice nurse, or parish nurse. (In parish nursing, also called faith community nursing, the members of a faith-based community, typically the parish or the community the parish serves, are the recipients of care.) These roles have one element in common: a focus on community needs as well as the needs of individual patients. The community health nurse cares for clients in the homeless setting along with in family and friend settings. The primary concepts of community-based nursing care are preventive care and self-care within the context of culture and community.

A nurse working in the community is involved in secondary prevention. Which activity would most likely apply?

Health screening for diabetes risk Explanation: Secondary prevention focuses on health maintenance and is aimed at early detection and prompt intervention to prevent or minimize loss of function and independence, including interventions such as health screening and health risk appraisal. Primary prevention focuses on health promotion and prevention of illness and disease, including interventions such as teaching about healthy lifestyles, for example, a nutritious diet. Tertiary prevention focuses on minimizing deterioration and improving the quality of life, including rehabilitation such as bowel retraining and exercise to assist clients in achieving their maximum potential.

Which type of healthcare institution provides care to residents for the remainder of their lives?

Long-term care Explanation: Long-term care provides care to residents for the remainder of their lives. An example of in-and-out care is an emergency department visit. Short stay provides care to clients who suffer from acute conditions or need treatments that entail less than 24 hours of care and monitoring. Acute care occurs in hospitals where clients stay more than 24 hours but less than 30 days.

According to the 2013 OASIS data study, which client would be at greatest risk for re-hospitalization?

Male client who requires assistance to ambulate Explanation: According to the 2013 OASIS data study, the client at greatest risk for re-hospitalization is the male client who requires assistance to ambulate. According to the study, factors that increased the likelihood of re-hospitalization included: male gender, mid-level cognitive impairment, decreased ability to perform ADLs, or support deficits (psychosocial, financial, environmental).

Which element is least likely to be a characteristic of an expected outcome of a nursing intervention?

Nurse-centered Explanation: Expected outcomes of the nursing interventions must be stated in terms of patient behaviors and must be realistic and measurable. They must reflect the nursing diagnosis or the patient's problems and must specify those actions that address the patient's problems.

The nurse is providing a community education program about sexually transmitted infections for a group of 13- to 16-year-olds. What type of prevention is the nurse targeting?

Primary prevention Explanation: Nurses in community-based practice provide preventive care at three levels: primary, secondary, and tertiary. Primary prevention focuses on health promotion and prevention of illness or disease, including interventions such as teaching about healthy lifestyles. Secondary prevention centers on health maintenance and is aimed at early detection, with prompt intervention to prevent or minimize loss of function and independence, including interventions such as health screening (Fig. 2-1) and health risk appraisal. Tertiary prevention focuses on minimizing deterioration and improving quality of life, including rehabilitation to assist patients in achieving their maximum potential by working through their physical or psychological challenges. Home care nurses often focus on tertiary preventive nursing care, although they also address primary and secondary prevention.

A novice public health nurse desires to learn more about developing professional cultural competence skills. What action by the nurse would best support the nurse's goal?

Reflecting on own cultural beliefs Explanation: Self-reflection about one's own cultural beliefs best supports the nurse's goal to develop cultural competence. Reading and caring for various cultures help to develop cultural awareness, but not necessarily competence. Describing differences between cultural practices does not address relevant concepts related to implicit bias. As such, in order to develop one's professional cultural competence skills, this must include self-reflection.

The nurse is caring for a patient who is to be discharged from the acute care facility to a rehabilitation unit after having a stroke. What type of prevention is this considered to be?

Tertiary Explanation: Nurses in community-based practice provide preventive care at three levels: primary, secondary, and tertiary. Primary prevention focuses on health promotion and prevention of illness or disease, including interventions such as teaching about healthy lifestyles. Secondary prevention centers on health maintenance and is aimed at early detection, with prompt intervention to prevent or minimize loss of function and independence, including interventions such as health screening (Fig. 2-1) and health risk appraisal. Tertiary prevention focuses on minimizing deterioration and improving quality of life, including rehabilitation to assist patients in achieving their maximum potential by working through their physical or psychological challenges. Home care nurses often focus on tertiary preventive nursing care, although they also address primary and secondary prevention.

A home care nurse is planning to visit a client newly diagnosed with diabetes. Further review of the chart reveals the client is of Japanese heritage. Upon arriving at the home, the home care nurse observes several pairs of shoes on a mat next to the door. Which of the following actions by the nurse demonstrates cultural competence?

The nurse removes her shoes and announces her arrival.

Which tools do case managers commonly rely on to plan and coordinate client care?

clinical pathways, practice guidelines, and standards of care Explanation: Case managers make use of tools such as clinical pathways, practice guidelines, and standards of care to help them plan and coordinate care. Hospitals and insurance companies may develop their own or rely on published protocols for guidance. Drug formularies are not tools used by case managers in planning and coordinating care. HIPAA regulations and EMRs are not tools used by case managers in planning and coordinating care. Outcome data and staff rosters are not tools used by case managers in planning and coordinating care.

A public health nurse describes the role of the nurse in public health to a group of community stakeholders during a budget meeting. Which category of care will the nurse place public health nursing?

Community-oriented nursing Explanation: Public health nursing combines the discipline of public health with community nursing and is considered a specialty practice within community-oriented nursing.

Which type of care is used for clients with terminal illness who have a life expectancy of less than 6 months?

Hospice care Explanation: Hospices provide care for clients with terminal illness whose life expectancy is less than 6 months. Ambulatory care is also called outpatient care. Skilled nursing care facilities provide skilled nursing and rehabilitative care to people who have the potential to regain function but need skilled observation and nursing care during an acute illness. Intermediate care facilities are nursing homes that provide custodial care for people who cannot care for themselves because of mental or physical disabilities.

A nurse who is considering the possibility of becoming involved in home care asks a home care nurse about the characteristics needed for this practice area. Which of the following would the home care nurse be least likely to include?

Need for control over a situation Explanation: A nurse working in home care needs to be comfortable with the minimal control that he or she has over the lifestyle, living situation, and health practices of the clients being served. In addition, the home care nurse must demonstrate a nonjudgmental attitude and convey respect for the clients' beliefs, even if they differ sharply from those of the nurse. Moreover, the home care nurse must be able to improvise when providing care in the home because the kind of equipment and supplies or resources usually available in acute care settings are often not available in the home.

A novice nurse is learning the difference between community-based nursing and community-oriented nursing. Which scenario does the nurse recognize as a role of the community-oriented nurse?

Nurse working a booth at a health fair performing blood pressure and glucose screenings Explanation: Community-oriented nursing targets improving the health status of groups of clients or individuals in the community. Community-based nursing is directed toward individuals and families with needs related to illness, injury, or disability. The health fair functions to promote improvement of health status while the other answer choices represent teaching or interventions in response to illness, injury, or disability.

A client in an acute care facility is assigned a case manager to oversee and coordinate care. What important function does a case manager have?

Provide early, thorough discharge planning. Explanation: An important function of case managers is to provide early, thorough discharge planning. The case manager is not responsible for the administration of medications. Hospice care provides care to the client who is terminally ill. The case manager oversees the care of the clients while they are hospitalized. Referrals to community agencies and home healthcare will be made for home visits.

Which level of prevention focuses on minimizing deterioration and improving quality of life?

Tertiary Explanation: Tertiary prevention focuses on minimizing deterioration and improving quality of life, including rehabilitation to assist patients in achieving their maximum potential by working through their physical or psychological challenges. Primary prevention focuses on health promotion and prevention of illness or disease. Secondary prevention centers on health maintenance and is aimed at early detection and prompt intervention to prevent or minimize loss of function and independence. Outpatient is not a level of prevention.

A nurse works in a community setting that deals with a large number of homeless individuals. Which of the following would be most important for the nurse to understand?

The health problems faced by homeless people are often related to their living situation. Explanation: Many of the health problems faced by the homeless population are related in large part to their living situation. Street life exposes people to the extremes of hot and cold environments, compounding their health risks. Additionally, the problems are made more difficult by living on the streets or discharge to a transitory, homeless situation with little or no follow-up care. Shelters are often overcrowded and unventilated, promoting the spread of communicable diseases. The homeless typically seek health care late in the course of the disease due to the numerous barriers. Homeless people have high rates of trauma, tuberculosis, upper respiratory infections, poor nutrition, anemia, lice, scabies, peripheral vascular disease, sexually transmitted infections, dental problems, arthritis, and other conditions. Nurses dealing with the homeless population must recognize that individualized treatment strategies are needed in a highly unpredictable environment.