BIOC33H3 Lecture Notes - Dietitian, Physical Therapy, Palliative Care
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Chapter 7: Community-Based Nursing and Home Care
The focus of community-based nursing is the illness-oriented care of individuals and families
throughout the lifespan.
Many factors are changing the health care system, including socioeconomic status,
demographics, prevalence and type of illness, technology, and increased consumerism.
The goals of case management are to provide quality care along a continuum, decrease
fragmentation of care across many settings, enhance the patient’s qualify of life, and contain
The use of Diagnosis Related Groups (DRGs) has had a dramatic impact on health care.
Health care is constrained by third-party payer cost containment.
Community-based settings where nursing care is delivered include ambulatory care, transitional
care, and long-term care (skilled nursing, intermediate care, and residential care facilities).
Community-oriented nursing involves the engagement of nursing in promoting and protecting
the health of populations.
Home health care may include health maintenance, education, illness prevention, diagnosis and
treatment of disease, palliative care, and rehabilitation.
Skilled nursing care may include observation, assessment, management evaluation, teaching,
training, administration of medications, wound care, tube feeding, catheter care, and behavioral
In home care situations, it is common for caregivers to become physically, emotionally, and
economically overwhelmed with responsibilities and demands of caregiving.
The home health care team may include the patient, family, nurses, physician, social worker,
physical therapist, occupational therapist, speech therapist, home health aide, pharmacist,
respiratory therapist, and dietitian.
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