Assignment | Community Nursing Practice

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Community Nursing Practices
Risks associated with care delivery in the community settings
Literature Review
University
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Introduction
Community nursing has been defined as nursing care delivery in settings outside acute
hospitals, general practice facilities, police custody, schools or at homes. Currently, more and more
patients are receiving care outside the traditional settings, with the increasing number of those
seeking medical attention outside hospital setups, nurses continue to adapt to these changing roles
in the health care setting. A community nurse is engaged in a wide variety of environments in
meeting the needs of the patients. The training of community nurses is fundamental in offering basic
care, injections administration, assistance with medical examination, cleaning and dressing wounds
and setting up of interventions drips and monitoring care delivery. Community nurses play a
fundamental role in offering education and advisory services to families and patients concerning
various aspects of health care. The tasks comprise high-pressure jobs which often change from day
to day and often are faced with a lack of adequate resources that are available in the hospital
(Seibert, 2015).
Health care revitalization in primary health care often requires changes in health care
education and training for the health workforce to be able to adapt to health care demands. Nurses
working in community settings have to undergo reorientation towards their thinking and practice
which focus on promotion and prevention of people's health. World Health Organization has come
up with a framework model to guide nursing education and guidance framework for nurses working
in community settings (WHO, 2012). This review explores the risk associated with community
nursing practices. Literature has been searched to identify the risk community nurses often face in
the line of their duty and its impacts on the nursing practices.
Community nursing risks
In Australia, it is estimated that about 25% of health care professionals are engaged in rural
settings. These health care staff are often prone to occupational associated injuries, work-related
disability and have an increased risk of prolonging work duty due to issues related to workplace
safety and health. In various cases, risk factors have been categorized as those related to heavy
workloads, long working hours, increased stress levels, minimal support, and violence-related
aspects, (Sheikh et al., 2013). It has been viewed that greater health workforce demand in
community settings is related to both intrinsic and extrinsic challenges in rural settings. These entail
aspects related to poor health outcomes and lower life expectancy. Further, there is an observance
higher rate of disability, violence, accidents, and violence-related aspects, (AIHW, 2013).

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The diverse nature of the health care system leading to delayed health acquisition and
poor health state in community settings imply health care nursing staff, (Chao, Jou, Liao & Kuo,
2015). Community nursing practices have been recognized as the key synthesis for public health care
practices and nursing applicable to protection and promotion of the general population health state
and key towards maximizing the overall health state of the individuals, groups and communities
(Deravin, Francis, Nielsen & Anderson, 2017). In rural and community settings community nurse
plays crucial roles as a generalist due to the lower number of the populations thus hampering care
delivered (Spetz, Skillman & Andrilla, 2017).
Work health and safety seek an avenue to offer protection and safety of health care staff
and all the individuals working in the community from hazards related to health care delivery
(Hilgert, 2012). In the health care context, community nurses experience stressors related to work
health and safety which are evident in daily practices. These stressors range from poor quality of
care, employment dissatisfaction, and workload in health care. Other related stressors are linked to
cognitive, behavioral, physical and emotional stressors in the health care workplace.
Search strategy
The search strategy entailed Medline search for 2009-2019, CINHL for 2009-2019 and
Embasse database for 2009-2019. The search entailed a full study review of the studies. The search
strategy was tailored to each of the databases used with medical subject headings in line with the
topic of interest. The inclusion criteria of the studies identified community nurses in community
settings. The scope of nursing practice was wide and was not limited to any specific specialty. All
studies searched were those of less than 10 years and below. The exclusion criteria obtained
entailed nursing practice undertaken in facility settings and those beyond the ten years of interest.
The search further scan through the studies found and analyzed them thematically for analysis
purposes and to inform on a critical discussion point of view.
Literature review
Stress and burn out
Stress is often a common issue facing nursing practices, especially in community setting
populations. Greater exposure to stress-related factors leads to the takeaway of work from home
(Newman & Berens, 2010; Barrett, Terry, Le & Hoang, 2015). Factors related to emotional demands,
staffing related issues, the pressure of work, work expectations, poor work management and safety
issues linked to psychological distress and trauma and exhausting there emotion levels. Other factors

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linked to stress in rural settings have entailed inability for staff replacement, lack of leave for
personal and professional development, (Kaasalainen et al., 2013).
Workload
Difficult management of workload and stress often end to be linked to excess work
compared to challenging care situations. Elevated workload has been shown to have adverse effects
on the quality of care community nurses offer to their patients in community setups, leading to poor
patient outcomes related to dissatisfaction (Bronkohorst, Tummers, Steijin & Vijverberg, 2015).
Further, community nurses work without any breaks with the majority of having busy schedules
seeing patients. A study by Newman and Berenes (Newman & Berens, 2010), have shown that about
90% of the community nurses take lunch at odd hours while 10% did not have sufficient time to take
lunch or they took while in their cars on transit. In the majority of the cases, limited time was
allocated for morning and afternoon breaks.
Environment
Additional impact on community nursing practices entails increased workload. Community
nurses travel long distances across client houses which often is time-consuming and strenuous.
Besides these difficulties, the accessibility of roads is not well developed. There is an access
challenge concerning geography and the climatic state of the rural areas increases the overall
vulnerability aspects of health care access in rural settings. Compounding to these, weather-related
aspects and injury lead to challenges and increased risks in the care delivery process, (Opie et al.,
2010).
Physical injury
Physical hazards are common in community nursing practices. These entail chemical
exposure, mechanical, biological, smoke and other related infectious agents (Rainsford et al., 2017).
The common prevalent form of injury is linked to musculoskeletal disorders which include soft
tissues and the surrounding structures which occur on the neck, elbow, lower back, feet and neck
regions. A study by Newman and Berenes (2010) showed that about 48% of community nurses
encounter workplace injury which leads to absenteeism affecting the work delivery process.
Work violence
Statistics in Australia have indicated that 86% of the remote nurses have reported aspects
of violence in workplaces in the previous year compared to urban nurses. Further, they have

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indicated critical delay words receiving support in cases of experiencing violence. There is no clear
indication of rural health care workings having an impact on increased risks of violence in the
workplace (10). Violence experience in the workplace has shown destructive outcomes and negative
impact on the overall professional and lives of the concerned health care staff furthermore affecting
the care quality they offer. This attributes to declined health quality outcomes to clients towards
poor work delivery. These aspects lead to reduced levels of health care services offer dint he
community settings, (Hunsberger et al., 2009; Barrett, Terry, Le & Hoang 2015). Nurses often
experience work health and safety issues however literature has focussed on remote areas in rural
communities. Overall assessment of risks related to community nursing practice is essential for
health care planning and ensuring a check on the quality of care offered.
Discussion
Various issues have been identified as fundamental risks in nursing care practice. Nurses
often endure long-distance traveling in the community settings, posing greater hazard exposure in
the workplace, bearing in mind the long period during travel time, conditions of the roads and
weather aspect of the community. Other aspects entail an encounter with adverse risks in remote
locations such as wildlife while driving and looking for client addresses while on the road. Nurses
face extreme risks with regards to extreme weather experience conditions which impacts negatively
on their health status. Extreme hot and cold environment causes palpable risks to the community
nurses in practices (Richards et al., 2018).
The majority of the nurses work in isolation and often at times they are vulnerable to
various burn out issues and lack of moral support. Studies have illustrated that community nurses
work on their own with the clients at workplaces. In these remote areas, access to communication is
always a challenge. These concerns have increased associated risks concerning safety and individual
working losing contact communication with their support team (Ellis, 2019).
Further, isolation working patterns impact on the working of the people in the homes.
Community nurses often encounter challenges that are not often observed in acute care settings.
These entail challenges concerning poor home structures, smoking-related behaviors, domestic
issues at the family unit of clients, risk of falls and emerging tensions concerning community and
home care modification practices in an attempt of modifying care of clients.
Clients at home settings have been shown to exhibit negative client behavior which posse
hazardous risks to the community nurse. Overcoming aspect of poor behavior and aggressive
behavior instances have been shown to have an impact on the overall care services rendered by

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community nurses. The most fundamental negative client behavior is linked to verbal abuse and
physical aggression. These actions possess negative risks on nurses’ affecting their care delivery
(Bender, 2016).
Overcoming violence-related issues call for adequate coping strategies for nurses and
undertaking risks assessment in the community. Despite this protocol, studies have shown that there
is no clear policy guideline to guide risks assessment o community nursing practices. The majority of
the opinions often found are based on the experience and advice of practicing community nurses.
There is a need for an adequate education to the nursing community on the violence-related aspects
in health care practices.
Associated musculoskeletal problems have been attributed to workplace safety aspects.
Assessment of risk assessment of clients' homes is vital to inform appropriate nursing practice. There
is a need for community nurses to further equip themselves with adequate work, health and safety
practices which offers an avenue for adequate planning. Further beyond education approaches,
there is the need for exercise activity intervention linked to strengthen and aerobic aspects to
nursing staff to aid strength-building avenues to adapt to environment-related risks, (Joseph, Skinner
& Yantzi, 2013).
Apart from the day to day issues with work, health and safety aspects, addressing aspects
related to workload has been an essential aspect of managing risks related to work in community
settings. Other issues have entailed overall organizational issues which hampers the management of
care quality aspects. Lack of adequate preparation towards community nursing practice has a
hindrance to care delivery increasing the risks of associated care outcomes of clients in the
community. Addressing workplace demands is essential in nursing practices, enhancing coping
mechanism is fundamental in nursing practices. Seeking social support is beneficial towards reducing
the risk associated with community nursing practice.
Conclusion
Generally, workplace-related risks are often experienced in increased episodes in
community settings. This review has highlighted various aspects relating to community nursing care
practices which play a fundamental role in the overall delivery of health care among the clients in
these settings. Workplace related health and safety have been linked to environmental challenges
that increase risks that the nurses face in the care provision process. Equipping nursing skills is
beneficial towards ensuring there is an adequate coping mechanism to be incorporated in
community nursing practice among the nurses. Addressing the risks highlighted in this context is

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essential towards addressing avenues on how to cope up with challenges concerning community
nursing practice.

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https://apps.who.int/iris/handle/10665/204726