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Nursing Roles in Community Health

Stephaine Ryan
Ferris State University

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Abstract
In this paper, the author discusses two different nursing roles. The two roles are that of a direct
care nurse and an indirect care nurse. Each nurse role has some similarities and differences in
nursing skills and leadership characteristics which are explained in the paper. An example of a
similarity is when caring for the patient population of teen pregnancy and teen motherhood. Each
nurse role will have to educate, communicate and collaborate well with many different medical
providers and organizations to provide adequate care to the teen and their family. A difference
between each nurse role is that the direct nurse cares for the patient directly, one-on-one; where
the indirect nurse could care for an entire population or community.
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Community nursing has an important role in preventing and treating illness as well as
educating the public on improving their health. Ms. Gail Harkness and Ms. Rosanna DeMarco
state in their textbook, Community and Public Health Nursing (2012), community health nursing
is the use of systematic processes to deliver care to individuals, families, and community groups
with a focus on promoting, preserving, protecting and maintaining health (p.3). One area that a
community health nurse can have a positive impact is teenage pregnancy and teen motherhood.
The purpose of this paper is to review the impact of a community nurse on a patient that is a teen
mother and/or dealing with teenage pregnancy.
Nursing Roles in Community Health
Types of Nursing Roles
There are two types of nursing roles used when a community project is being
implemented. One nursing role is the direct contact nurse. A direct contact nurse cares for a
patient directly. An example would be a community health nurse that goes to the home of the
patient and cares for him or her on a one-on-one basis. The second type of nursing role in the
community is the indirect nurse. This nurse could be the manager of the unit or community
nursing project. The indirect nurse doesnt have direct contact with the patient under the care of
the direct nurse. Each has an impact on the care and improvement of the patient and
communitys health.
Role of Direct Contact Nurse
A direct contact nurse is a home health care nurse or a community nurse that goes to the
home of the community member to provide care for injuries or illness. It has been studied that a
community nurse having contact with the pregnant teen or a teen mother can decrease the
amount of repeat pregnancies, decrease infant hospitalizations and infant emergency room visits.
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These community nurses can also increase the teens ability to parent the child, the rate of
completing school with graduation, and increases the bonding between the mother and the infant
(Schaffer et al., 2012). The direct care nurse would educate the mother and family on the
importance of a proper diet throughout pregnancy and for the infant. The nurse could also
facilitate referrals to the proper specialists for more specifically tailored healthcare as well as
organizations to get the proper items to care for a new infant if those are needed. These two types
of referrals would be an example of the American Nurses Associations (ANA) Standards of
Professional Performances Standard of Collaboration. The direct care nurse works with not only
the mother but the family, doctors and organizations to help provide the mother with the best
care possible. The nurse must also be very good at completing an assessment of the mother and
the family to help find the areas that are in need of improvement or where assistance is needed.
Leadership characteristics that a direct care nurse would have are those of mentoring
and being charismatic, educational, encouraging and communicative (Anonson et al, 2013).
When caring for a newly pregnant teen a nurse must mentor the patient. It has been studied that a
teen that has a positive mentor during pregnancy and the first years of motherhood have positive
effects on the new mother (Meghea et al, 2011). Some other characteristics that a direct care
nurse should have while caring for others especially pregnant teen and teen mothers are being a
pioneer, a role model, change agent and advocate (Mannix, Wilkes & Daly, 2013). In a study by
Schaffer et al. (2012), it was proven that a teen that has a role model and advocate that provides
care and education to improve the teens health and parenting leads to better outcomes and
greater sense of independence (p.219). It was also proven in the study that the teen gains
skills in stress management, improving self-esteem and managing depression (p.219).
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Role of a Leader/Manager Nurse
A nurse that is a leader or manager doesnt always have direct contact with the patient. A
role that this nurse may have is a case manager, unit manager or manager of care agencies. These
nurses lead not only care for the patient indirectly but lead the direct care nurse(s) that are caring
for a patient(s). A leader/manager has to make sure that every nurse on the unit or in the
organization is working well together. An example is leading an entire unit or organization of
nurses to give the best care to patients on the unit or in the care of the organization.
While a teen is under the care of a nurse manager, he or she will coordinate care of the
teen and the infant. The case manager or a manager of an organization can work with the
community to provide items for teens and their families. The manager could reach out into the
community to ask people of means to help care for people who have very little (Schaffer et al.,
2012). The manager could also put together classes or clinics to educate the teen and the family
to care for the new infant. The manager could also make information to the new mother on
proper diet, immunizations and the milestones infants should reach at what age (Meghea et al.,
(2012).
The nurse manager uses many ANA Standards of Professional Practice. Some examples
of the standards are planning, education, resource utilization, collaboration and communication
(ANA, 2010). A manager will plan with the direct care nurse on interventions that will help not
only the patient in the unit or organization but it could also the community to prevent or improve
health. The manager uses resources in the community to help the teen and other teens in the
community to improve how they are caring for themselves and their infant. The manager must
work with many different health care providers, businesses and community members to help the
teen mothers. The manager must communicate with all of the professionals involved to
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coordinate care and provide for the needs of the patient. A manager abides by many of the same
Standards of Professional Practice as a direct care nurse but the manager applies it to not only the
patient but the community as well.
Analysis
The roles of the direct care nurse and the nurse leader/manager are the same in that they
are both working to improve the care of the patient(s). They both coordinate care with other
medical professionals and at times other organizations to get the needs of the patient(s) met. Both
the direct and indirect care nurses spend a lot of their time educating the patient and community
on ways to improve health and improve their lives.
The role of the direct care and indirect care nurse are different in that the indirect care
nurse concentrates more on the care of the entire community or portion of the population in need
of care. The portion of population that the indirect care nurse would concentrate on in this paper
would be teens and young mothers. The direct care nurse has more of a connection with the
patient. He or she gives care on a more personal level. That means that they care for the patient
on a more personal level. The indirect care nurse can have minimal contact with the patient. He
or she used the information obtained by the direct care nurse to provide care and make
interventions for the patient.
The roles of both of these nurses can influence the political parties in their area by
informing their representatives and political members to areas that need improvement. If the
nurses come together, write letters, make phone calls, and attend meetings they can be a part of
the change in the community. By bringing these topics to the forefront, community members can
become more educated on what would be needed to have change and demand change from their
political representatives.
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The skills needed for both roles of nurses are very similar. A nurse leader/manager has
the responsibility of leading many nurses. They must be better at communicating with many
different personalities at once. This can be difficult and make many people unhappy. A direct
care nurse does communicate with others but on much more of a one-on-one basis. A manager
must look at different sides of nursing than a direct care nurse. A manager often times need to
keep the business aspect of healthcare where the direct nurse is more often times just concerned
at caring for the patient at the present moment. He or she is concerned at giving the patient the
best care at the moment and not as concerned with the cost. The managers decisions can affect
the entire organization or unit where the direct care nurses decisions very often only affects the
patient they are caring for at the time.
Reflection
The skills that are possessed by the author that fits with the direct care nurse is that this
nurse often doesnt think of the cost behind giving a patient adequate care, but gives care to the
patient as she sees fit. The author also spends a lot of time educating the patient and their family
on caring for themselves and the new infant and tailors the education directly to the knowledge
of the patient. The skills that the author possesses that an indirect nurse would have is that this
nurse has to communicate with many different health professionals and organizations to provide
care for patients. Being able to work with many different people to provide the patient with what
is needed to care for the infant as well as themselves happens at every discharge from the
hospital.
Some of the role requirements that the author would find difficult would be to make
decisions that would affect an entire unit or organization. This nurse would think that it would be
too stressful to have the responsibility of making the unit be profitable. Now with more
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restrictions on reimbursement and less money coming into the hospital, making the decisions of
what needs to be removed would be difficult.
To become competent in the role of a nurse manager would be to become more educated
on the evidence-based information on how to make the best decision for the unit or organization.
This author has little experience with decisions that would affect an entire unit or organization.
After gaining knowledge on how to make the best decisions and working with the entire staff to
make the best decision this author would gain confidence and become a better manager.

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References
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