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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
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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
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Why is acute care nursing community based nursing?
Because acute care nurses do take care of individuals and families in a specific community
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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...
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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
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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
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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
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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)
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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
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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
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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
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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
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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,
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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
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Retirement communities
- Client functionally and socially independent
- Live with other seniors
- Accommodations include home with supportive services provided by community
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Assisted living facilities
- For individual who needs some assistance in daily activities (bathing, dressing,...)
- Functionally fairly independent
- Bedrooms in homelike environment
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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
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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
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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
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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
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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
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Boarding Care Homes
- Personal custodial care for clients who cannot live independently.
- Do not have nursing or medical supervision/care.
- Clients usually stay indefinitely
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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.
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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
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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
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camps
- Camps for children with chronic illnesses,
- Reg. private or church camps
- E.g. educational asthma camp (education, social, emotional advantages...)
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Rehabilitation centers
- drug dependency treatment
- goal: help clients reach optimal health
- -> become part of productive community again
- Direct care, teaching, counseling
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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
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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
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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
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