Archive for December, 2008

Community Health

Parris and Hines (1995) recommend a commitment to a community-based approach to reform the system of health care delivery. Community-based care focuses on prevention and primary care. Community health nurses work in a variety of settings, including homes, clinics, workplaces, schools, church parishes, and organizations. They are skilled at providing services to populations at high risk for illness, homeless persons, aging populations, and those experiencing chronic illness. Regardless of the setting, fundamental principles of community care include the following (Hunt, 1998):
• Focusing on prevention
• Advocating client self-care
• Interactive nature between family, culture, and community
• Continuity of care
• Collaborative care

Public versus Private Programs

The combination of public and private sector resources for health care seems to be comfortable for Americans. The competition between the two types of settings has encouraged quality and progress. Each setting provides benefits as well as drawbacks to health care recipients. The nursing profession supports an integration of public and private sector programs and resources. Public dollars are required to help the poor and those who do not receive health care benefits through the workplace. Actual services should be available through a variety of public and private sources. To safeguard the health care system from becoming a two-tiered process based on personal resources, both the poor and nonpoor and the privileged and nonprivileged must be enrolled in the same programs.
Finally, the basic required package of services must be defined in the same way in each state and required as the minimum for both public and private sector programs. The persistence for national standards must be tempered with a respect for local needs and differences. In other words, set minimal national standards, but promote local planning and implementation. Local insights are particularly critical to the public health, meaning the health of a community as an aggregate of people, and not personal health services delivered in the community. The states’ rights philosophy prevailing in the United States creates an obstacle to national standards, which are necessary for several areas of assurance. Some coastto- coast consistency in the cost of services is needed with local area adjustments. Further, a national standard to qualify for public entitlement is long overdue.

Changing Practice Settings

Most nurses currently practice in hospitals and will continue to do so in the future (Aiken, 1995). However, there is an ever-increasing need for nurses in different areas of practice. Social and political changes are affecting nurses by creating the need for expanded services and settings. Because of these changes, demand for nursing care fluctuates. For example, nursing employment outside the hospital continues to increase rapidly. Health care expenditures for home care are rapidly increasing. It is predicted that 70%–80% of care will be delivered in the home by the year 2010 (Conger et al.,1999). Since the advent of Medicare and Medicaid, home health care has grown rapidly.
More nurses will be needed in the future due to:
• The growing elderly population will require more health care services.
• The number of people admitted to nursing homes is steadily growing.
• The number of homeless individuals, who are most often denied access to health care, is increasing.
As health care reform occurs, some nurses may be displaced from their current jobs. But overall, many more jobs will be created by the demand for greater access to health care services. Some examples of areas in which larger numbers of nurses will be required are
primary care, public health, extended care facilities, and the home setting.