Hi Professor Payne and class,

The community setting that I chose was hospice nursing. Having worked in-facility hospice and community hospice off and on, I have seen the difference between the two. As Nies and McEwen (2019) noted, “nurses who work with the terminally ill seek to enhance the patient’s quality of life by focusing on relieving suffering throughout the illness, supporting the patient and family through the dying process….” (p. 683). The community hospice nurse visits patients that are either living in their homes or an assisted living/long term care facility. Many of the patients have terminal illnesses such as cancers, AIDS, cardiac, respiratory, end-stage diseases, etc. Many times, the hospice nurses provide extensive education regarding non-pharmacological and pharmacological methods, disease process, signs and symptoms of impending death, etc. to patients and their families because there are often misconceptions about hospice.

Tertiary prevention targets populations that have experienced disease or injury and focuses on limitation of disability and rehabilitation; keep health problems from getting worse, to reduce the effects of disease and injury, and to restore individuals to their optimal level of functioning (Nies & McEwen, 2019, p. 7). I think this is a more appropriate level of prevention since hospice nurses concentrate on holistic care and symptom management, which can include pain, dyspnea, anxiety, nausea and vomiting, constipation, and terminal restlessness (Crusse & Messler, 2014). Tertiary prevention allows for the hospice nurse to educate patients and families on prevention of worsening symptoms, and providing the patient with medications and/or equipment to help with quality of life improvement and symptom management (i.e., oxygen, bedside commodes, geri chairs, nebulizers, wheelchairs, hospital beds, and medical supplies).

References

Crusse, E. P., & Messler, T. (2014). Hospice care is comfort care. Nursing Made Incredibly Easy!, 12(3), 40-48. doi: 10.1097/01.

Nies, M. A., & McEwen, M. (2019). Community/public health nursing: Promoting the health of populations (7th ed.). St. Louis, MO: Saunders/Elsevier.

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