NSG/482 Week 1: Family and Community Health Nursing, sample paper

From the Bedside to the County Line: Community Health Nursing Roles in a Rural County With a Closed Hospital

[Student Name]

University of Phoenix

NSG/482: Promoting Healthy Communities

Week 1 Assignment

[Instructor Name]

[Date]

The county, clinic and figures are a composite written for a model paper.

When the only hospital in a composite rural county of 21,000 people closed its inpatient unit, a registered nurse who had worked medical-surgical shifts there for nine years took a position with the county health department. Her first week made the difference between the two jobs plain. At the hospital her patient was the person in the bed, and her work ended at discharge. At the health department her client was the county: the 21,000 residents, the families they lived in and the conditions that shaped their health long before anyone reached a hospital bed. Community health nursing does not begin where hospital nursing ends; it begins where most health is actually made, in homes, schools, workplaces and the decisions a county makes about them. This paper describes community and family health nursing, applies the levels of prevention to the county's needs and examines the roles the nurse now fills.

Community Health Nursing Defined

Community health nursing is the practice of promoting and protecting the health of populations, using knowledge from nursing, social and public health sciences. Stanhope and Lancaster (2020) distinguish between community-based nursing, which provides care to individuals and families where they live, and community-oriented or public health nursing, which treats the population itself as the client. A home health nurse changing a wound dressing practices in the community; a public health nurse analyzing why wounds from uncontrolled diabetes are rising across the county practices on behalf of it. Both matter, and the nurse in this county will do both.

The family sits between the individual and the community. Families share environments, routines, food, beliefs and often illness risks. A nurse who teaches one member about diabetes but ignores who cooks, who shops and who drives to appointments will see the teaching fail at home. Family health nursing therefore treats the family as both the context of an individual's care and, at times, as the client in its own right.

The County as Client

The county's health profile explains why the nurse's new work looks the way it does. Adults in the county smoke at a higher rate than the state average, adult obesity affects more than a third of residents and the county has fewer primary care providers per resident than most of the state. After the closure, the nearest emergency department is 38 miles away. About one in five children lives in poverty, and the school district reports that a large majority of its students are eligible for subsidized school meals. Older adults make up a growing share of the population as younger families move to larger towns for work.

The Institute of Medicine (1988) defined the mission of public health as fulfilling society's interest in assuring conditions in which people can be healthy. In this county, those conditions include distance to care, poverty, tobacco use and an aging population, none of which a hospital nurse could address from a bed on the medical unit.

Levels of Prevention Applied

The three levels of prevention give the nurse a way to sort the county's needs into action.

Primary prevention aims to stop disease before it begins. In this county that includes tobacco prevention in the middle and high schools, influenza and pneumococcal immunization clinics held at churches and the senior center, and work with the school district on physical activity. The largest gains in health often come from primary prevention, but they are the slowest to appear in the data.

Secondary prevention detects disease early, when treatment works best. The nurse organizes blood pressure and diabetes screening at the county fair and the farm supply store, where adults who avoid clinics are likely to be, and follows every abnormal result with a referral and a phone call. Without follow-up, screening only finds problems; the phone call is what turns a result into care.

Tertiary prevention limits disability from established disease. With the hospital gone, adults with heart failure and chronic obstructive pulmonary disease are at risk of worsening at home with no nearby emergency care. The nurse coordinates with the regional hospital's discharge planners so that county residents discharged after a heart failure admission receive a home visit within a week, a scale for daily weights and a clear plan for whom to call.

The Nurse's New Roles

Keller et al. (2004) describe a set of population-based public health nursing interventions, organized as the Minnesota intervention wheel, that apply at three levels of practice: the individual and family, the community and the system. The framework helps explain how the nurse's week is divided. At the individual and family level she provides case management and health teaching, such as the heart failure home visits and the follow-up calls after screening. At the community level she leads health education and immunization clinics and builds coalitions with churches, the school district and the senior center. At the systems level she advocates for policy, such as a request to the county commission to fund a community paramedicine pilot so that paramedics can check on high-risk residents between visits.

Stanhope and Lancaster (2020) also describe the community health nurse as a collaborator, a researcher who uses data to find needs and a case manager who links families to resources. The loss of the hospital made the last role especially important. When care is 38 miles away, a nurse who knows which families lack a car, which neighbors can drive and which clinics offer telehealth can decide whether a resident gets care at all.

What Changes for the Nurse

The move from hospital to health department changed more than the setting. On the medical unit, success was visible within a shift: pain controlled, a wound healing, a patient discharged. In the county, the results the nurse works toward, fewer teenagers who start smoking or fewer heart failure readmissions, take years to show and depend on many people besides her. She now measures her work partly through process indicators, such as the number of adults screened and the share of abnormal results with a completed referral, while the county's longer-term outcomes are tracked through the state's annual data. Learning to value work whose effects she may not see is part of becoming a community health nurse.

A Family Within the County

One family shows how these levels connect. A 67-year-old man with heart failure lives with his wife, who has diabetes, and their 15-year-old grandson, whom they are raising. At the individual level, the nurse visits after his discharge to review daily weights and medications. At the family level, she notices that the wife manages both of their medications, the grandson does most of the cooking, and the family's meals rely on inexpensive processed food high in sodium. Teaching the grandson how to read labels and cook two low-sodium meals helps both grandparents. At the community level, the family's situation, grandparents raising grandchildren with chronic illness and limited transportation, is common in the county, which leads the nurse to propose a kinship caregiver support group through the extension office.

Conclusion

Community health nursing treats the family and the population as the client and works upstream of the hospital, in the places where health is shaped. In a rural county that lost its hospital, a nurse's role shifted from caring for the patient in a bed to preventing disease through schools and immunization clinics, finding it early through screening where people already gather and limiting its harm through home visits and coordination. The intervention wheel shows that this work spans individuals, families, communities and systems, and the hospital's closure makes each level more important, not less.

References

Institute of Medicine. (1988). The future of public health. National Academy Press. https://doi.org/10.17226/1091

Keller, L. O., Strohschein, S., Lia-Hoagberg, B., & Schaffer, M. A. (2004). Population-based public health interventions: Practice-based and evidence-supported. Part I. Public Health Nursing, 21(5), 453-468. https://doi.org/10.1111/j.0737-1209.2004.21509.x

Stanhope, M., & Lancaster, J. (2020). Public health nursing: Population-centered health care in the community (10th ed.). Elsevier.