Learning Objectives
By the end of this section, you will be able to:
- Discuss the nurse’s role in different community care settings
- Discuss care and collaboration efforts when caring for those experiencing homelessness
Nurses play a central role in a variety of health-care settings, including hospitals and community care settings, and address diverse patient needs. As the health-care industry shifts toward preventive and holistic approaches, nurses may find themselves leading efforts to offer services far beyond hospital walls. These settings can include health-care homes, schools, clinics, shelters, and beyond.
The Nurse’s Role in Community Care Settings
Nurses play vital roles in many community-based settings, providing health-care expertise and compassionate care beyond hospital environments. For example, nurses may work in community clinics to provide preventive care, health screenings, immunizations, and treatments for common illnesses, as well as health education to empower individuals and communities in making informed decisions about their well-being. Nurses may participate in community health initiatives focused on health promotion, disease prevention, and education. For instance, they might organize health fairs, workshops, or screening programs as an effort to engage and empower communities toward improving their own well-being. Rural and remote regions often rely heavily on nurses as primary health-care providers due to limited access to medical facilities, providing a full array of health-care services, such as assessment, treatment, medication administration, and emergency responses.
Nurses may also offer these services in correctional facilities. Correctional facilities employ nurses who offer health-care services for incarcerated people's acute and chronic medical needs, including administering medications, managing chronic conditions, conducting health assessments, and making health assessments to ensure incarcerated people's needs are being met within this special setting.
Nurses working at senior care facilities, such as assisted living centers or nursing homes, provide medical assistance for older adults in various forms. This may involve managing chronic conditions, administering medications, and overseeing overall well-being in these community-based environments. Furthermore, nurses also serve as advocates, educators, caregivers, and coordinators of care for individuals within this setting: their roles go well beyond simple medical duties by including activities to promote health, education, and emotional support and collaboration to increase well-being outcomes and enhance overall quality of life.
We cover some additional community care settings in more detail, including hospice care, ambulatory and outpatient services, occupational health programs, and school health programs.
Hospice Care
The hospice and palliative care settings offer compassionate nursing services for individuals living with life-limiting illness. Nurses provide pain management, emotional support, and education about end-of-life care, while assuring patient comfort and dignity.
Hospice nurses play an invaluable role in providing health care beyond hospital settings, ensuring that individuals receive comprehensive yet personalized attention in the comfort of their own environments. Hospice care, especially home hospice, can have a significant impact on individuals facing life-limiting illness and improving quality of life during its final stages. Community-based nurses are at the core of hospice care, offering compassion, expertise, and comprehensive support to both patients and their families. Beyond medical tasks alone, the nurse’s role spans emotional support, pain management, symptom relief, and education. They work in close cooperation with interdisciplinary teams composed of physicians, social workers, spiritual counselors, and volunteers to deliver tailored treatment to meet a patient’s specific needs. The hospice nurse focuses on the patient’s needs and supports family members and loved ones during the death and dying transition. Palliative care and hospice care often overlap in nursing care, but Table 36.3 shows how they are distinct.
| Palliative Care | Hospice Care | |
|---|---|---|
| What is it? | A focus on relieving the pain, symptoms, and stress of a chronic illness, which may not be terminal | A focus on providing care for patients at the end of life |
| What is the time frame of care? | No time frame | Generally lasting up to six months |
| What is the scope of service? | Interdisciplinary team may be involved for a variety of treatments | Interdisciplinary team is involved for pain management but not curative treatments |
| Where is care given? | Patient’s home, skilled nursing facility, assisted living facility, hospital | Patient’s home, skilled nursing facility, assisted living facility, hospital, hospice facility |
| Does Medicare pay? | Medicare Part B pays 80 percent of charges | Medicare Part A pays all hospice services |
| What other services are offered? | Telehealth, patient education, advance care planning | Complementary therapies, professional end-of-life care, telehealth |
Ambulatory Services
Outpatient health care or ambulatory services, also referred to as "ambulatory care,” refers to health-care services in which the patient receives care without needing hospital admission. Ambulatory care services aim to meet an array of medical needs, from preventive services such as routine exams to diagnosis, treatment, and management of various health conditions. Ambulatory services are typically found in clinics, medical offices, urgent care centers, specialty centers, and even prisons. These services are offered exclusively to those not needing hospitalization. Nurses working in outpatient settings conduct initial assessments and prioritize care according to urgency and necessity, gathering medical histories, performing vital sign measurements, and analyzing symptoms to guide appropriate interventions or referrals for each individual patient.
Ambulatory services cover an array of health-care needs, such as preventive services, diagnostic testing, imaging and laboratory analysis, vaccinations, physical therapy services, and minor surgery treatments, as well as follow-up visits for chronic disease management. Patients receiving outpatient services typically return home the same day after medical appointments or procedures performed at outpatient facilities.
Ambulatory services allow convenient access to health care without hospital admission being necessary. Appointments can often be scheduled at times convenient to patients, and services are designed to offer efficient and timely care without prolonged wait times. Whereas health-care facilities typically deliver outpatient services via scheduled appointments to manage patient flow more efficiently, ambulatory services provide flexible scheduling to make receiving care as painless and comfortable as possible without disrupting daily lives or routines. They play a pivotal role in provision of preventive services, early diagnosis of conditions, and effective management. Table 36.4 compares the various services offered in different health-care settings.
| Outpatient Care Settings | Services Provided |
|---|---|
| Ambulatory care | Lab work |
| Urgent care | Lab work, diagnostics, x-ray, first aid for acute medical problems, suturing, wound care, physical assessment |
| Health-care clinic | Visit with provider, diagnostics, medication prescribing, small treatments such as respiratory medications, wound care; nurses monitor progress with chronic disease management |
| Telehealth | Simple acute illness that can be treated by an online provider and that does not require suturing, x-ray, or lab diagnostics |
Occupational Health Programs
The field of health care focused on improving and protecting employees in their place of work is called occupational health. Occupational health programs aim to promote employee well-being and safety in the workplace. They incorporate various strategies and interventions designed to create a safer and healthier work environment by avoiding injuries, illnesses, and hazards. Nurses are an essential part of occupational health management, playing both advisory and managerial roles. Their responsibilities extend far beyond direct patient care to include health promotion, injury prevention, educational programs for both employees and employers, and collaboration among both parties involved.
Working closely with occupational safety specialists, nurses develop and implement safety protocols. They educate employees on workplace health and safety practices, such as appropriate ergonomics, the use of PPE, health screenings, and strategies to avoid injuries and lead a healthy lifestyle. Nurses assess workplace hazards, such as exposure to hazardous materials or musculoskeletal issues, and recommend measures to mitigate risks.
Occupational health nurses specialize in injury management and first aid response plans in workplace settings. They often can offer immediate attention for workplace accidents or refer the individual to an acute care outpatient facility for treatment. They administer first aid, assess injuries’ severity, and determine if further medical attention is required. Duties also include monitoring employees to ensure compliance with health safety standards: for example, checking N95 mask measurement, ensuring people are up to date on their vaccines, and administering flu or COVID vaccines. Occupational health nurses are also involved in health surveillance, performing periodic monitoring checks on workplace employees’ physical conditions for potential issues that might require medical intervention.
Occupational health nurses routinely monitor employees working in high-risk environments, such as those working with potentially harmful chemicals or on construction sites. By conducting regular health assessments, occupational nurses can detect potential health concerns early and initiate effective solutions. They help workers follow specific protocols after an injury to file an insurance claim for additional medical attention. By keeping detailed health records for employees’ medical histories and conducting regular assessments, occupational health nurses assist in tracking trends, pinpoint areas of concern, and support evidence-based decision-making processes. As a result, they can devise and implement wellness programs designed to promote healthier behaviors among employees, such as smoking cessation initiatives, weight management plans, stress relief techniques, and fitness activities. Nurses work collaboratively with employers and management to establish policies and practices to create a safe and healthy work environment, serving on safety committees while contributing their health-care knowledge in decision-making processes.
Nurses play an essential part in emergency response planning in the workplace. They educate employees on emergency procedures, conduct drills, and ensure medical supplies and equipment are readily accessible. Nurses also help employees who are returning to work after an injury by teaching them about emergency procedures, conducting drills, and ensuring medical supplies are quickly available should an incident happen. Nurses work alongside health-care providers to develop return-to-work plans that consider employees’ medical conditions and job demands, in cases of workplace injuries or illnesses. Nurses also serve as advocates and provide employee support services when workplace injuries or illnesses arise. Nurses play an essential part in developing an environment conducive to employee well-being by working alongside employers to create safe work environments that promote both physical and mental well-being.
School Health Programs
School programs, more commonly referred to as school health programs, are comprehensive initiatives created to support students’ physical, emotional, and academic well-being within an educational setting (de Buhr et al., 2020). School programs encompass various services, interventions, and activities designed to meet the physical, mental, and social health needs of pupils and staff.
Nurses serve as health-care professionals who can offer expert clinical knowledge and health education within a school environment. School nurses conduct a variety of assessments to determine students’ needs and detect potential health concerns. They conduct vision and hearing screenings, monitor growth and development, and assess overall health status. Nurses provide health education to students, staff, and parents on topics like nutrition, hygiene, sexual health prevention strategies, substance use reduction plans, mental wellness awareness campaigns, and safety precautions.
School health nurses may also administer immunization shots. Nurses take great care to record all necessary immunizations received by students, thereby helping to prevent contagious diseases from spreading within the school community and aiding efforts to manage chronic diseases. In an era of controversy regarding immunizations, school nurses help educate parents about vaccines, including criteria for exemption. School nurses also provide services for children experiencing chronic health conditions, such as diabetes, asthma, and allergies. They create individualized health plans, educate school staff about students’ needs, and ensure emergency medications such as EpiPens are easily available, should an emergency arise. Nurses in school settings are trained to respond promptly to medical emergencies in school settings—for example, injuries, allergic reactions, and seizures—and offer immediate emergency assistance if necessary.
One essential job of the school health nurse is to assess mental health needs and offer support to individuals experiencing anxiety, depression, trauma, and other forms of mental distress (Markkanen et al., 2021). Nurses should be able to recognize signs of mental health concerns in students, offer immediate assistance when necessary, and refer them to mental health professionals for further evaluation and intervention. Nurses provide counseling and emotional support for students facing health-related or personal difficulties, offering a safe space in which students may discuss or share any worries that arise. Collaborating closely with school administrators and staff members as well as parents and community resources, nurses organize health promotion events at school, such as health fairs, wellness workshops, and awareness campaigns. They also advocate for policies that foster an environment conducive to well-being at school.
School health nurses keep accurate health records on students, including immunization records, health assessments, and medical histories. They provide essential input when crafting health policies at schools to prioritize student well-being with respect to nutrition, physical activity, and other related matters. Nurses also provide an individualized care plan that outlines care requirements for each student with specific medical needs, for example, a child with diabetes or seizures (Potts et al., 2018). These personalized care plans outline necessary accommodations, interventions, and communication strategies in order to support each student’s well-being.
Caring for Persons Experiencing Homelessness
Caring for people experiencing homelessness requires a holistic and compassionate approach that recognizes the unique challenges and vulnerabilities affecting this population. Homelessness can result in physical, mental, and social health complications due to limited housing or resources, which must all be addressed simultaneously. Working with people without housing involves building trust, providing support, and helping them access resources that will improve their overall well-being.
Nurses play an invaluable role in meeting the unique health needs and vulnerabilities experienced by persons without housing, such as lack of access to basic health services and environmental conditions that exacerbate physical and mental illnesses. Nurses provide essential health-care services like wound care, immunizations, blood pressure monitoring, and treatment for minor illnesses or injuries. Wound care in particular can be an important element of infectious disease prevention. Nurses educate individuals experiencing homelessness about ways they can prevent infectious diseases like HIV, hepatitis, and tuberculosis by offering vaccinations and disseminating hygiene supplies.
When working with a patient without housing, the nurse should conduct a health assessment to detect and address immediate health concerns and establish an evidence-based framework for ongoing care (de Buhr et al., 2022). The assessment should cover physical and mental conditions, substance use, and any chronic conditions. People experiencing homelessness face a higher risk for mental illness and substance use disorders than the overall population in the United States (Narendorf et al., 2022). The assistance of a nurse could include counseling sessions or referrals to professional mental health services as well as crisis intervention strategies. Nurses address substance use by offering counseling services and referrals to treatment programs for substance use disorders. Nurses also educate individuals on safe injection practices and risks of overdose.
Nurses provide individuals experiencing homelessness with access to community resources such as shelters, food services, clothing donations, and employment assistance programs, as well as housing programs and social services. Nurses can also advocate for improved health-care access and social services for populations without housing and help raise awareness about the unique health challenges faced when experiencing homelessness. By working to meet the complex physical, mental, and social needs of this population, nurses contribute greatly toward improving individuals’ overall well-being as they journey toward stability through housing solutions.