NR443 Week 4 Discussion, Community Settings

NR443 Week 4 Discussion, Community Settings Community health nurses practice in a variety of settings. Choose one of the following CH settings, and describe what you have learned about the setting and the role(s) of the nurse in that setting (see Nies & McEwen, 2019, Chapters 30-34). Please do not choose school nursing for this discussion because your paper is on school nursing. • Home health nursing • Occupational health nursing • Forensic nursing • Hospice nursing Next study levels of prevention in this week's lesson (primary, secondary, and tertiary). Note that the term primary is used differently than in normal conversation. Describe one of the levels of prevention, and discuss how a community health nurse (CHN) in the setting you discussed can implement this level of prevention. The community health setting I chose for this week’s discussion is home health nursing. Home healthcare was initially reserved for wealthy citizens that could afford to hire doctors and nurses to come into their home and care for them or their family members. By the end of the nineteenth century, this luxury was extended to the poor to prevent the spread of contagious diseases. By the 1930s and 1940s, the increasing number of chronically ill patients were compromising the capacity of hospitals (Fulmer, 2017). Since the hospitals were assuming more and more responsibility for patient care costs, they decided it wouldn’t be unreasonable for the chronically ill patients to be treated at home for a lower cost since the families would assume the care giving responsibility. While home health nurses use health promotion to improve the patient’s well-being, trying to prevent and protect patients from the effects of a chronic disease are the main focus. “Leavell and Clark (1958) identified three levels of prevention commonly described in nursing practice: primary prevention, secondary prevention, and tertiary prevention” (Nies, 2019, p.7). Tertiary prevention is directed to patients that are already affected by a disease. A home health nurse would use tertiary prevention to focus on patients that have already been affected by an illness or disease and prevent the problem from getting worse. A home health nurse would also use tertiary prevention in patients that have chronic illnesses to reduce exacerbations. Education is an important part of tertiary prevention because if the patient fully understands the disease process, they can take precautions to aid inn their health. Nies (2019), uses the example of teaching insulin administration and diabetic education to a patient recently diagnosed with Diabetes. Not only is home health care a more affordable option, the convenience of bringing care to the home setting helps patients maintain their independence as much as possible. Home health nursing is not limited to chronically ill patients. Some home health nurses might perform wound care, long term IV therapy of antibiotics, or nutrition therapy (Nies, 2019). Not surprisingly, one of the most important aspects of home healthcare nursing is education. Nurses are responsible for educating the patients on why a certain type of medication or method is used. Different home health agencies offer a variety of services depending on the patient’s needs. The home health nurse will assess the need for other referrals depending on the individual patient’s needs. This may include occupational and physical therapy or the help from a social worker. According to Nies (2019), changes in how Medicare reimburses for home health care visits has significantly changed over the past 20 years due to The Balanced Budget Act of 1997 (BBA) (Public Law 105–33). Before this law was passed, home health agencies were reimbursed based on whatever the agency said the service would cost, known as retrospective payments. In the year 2000, the reimbursement method has been changed to a prospective payment system where the agency only receives a fixed amount based on the patient’s diagnosis and plan of care (Nies, 2019). In 2008 and 2012, the Centers for Medicare & Medicaid Services (CMS) have expanded coverage for more diagnoses and allotted more scheduled therapy visits, if necessary. Fulmer, H. (2017). History of visiting nurse work in America. Home Healthcare Now, 35(1), 33-33. Retrieved from: Nies, M. A., & McEwen, M. (2019). Community/Public health nursing: Promoting the health of populations (7th ed.). St. Louis, MO: Saunders/Elsevier.