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As community care for people with physical and mental health problems continues to expand, the nurse’s role expands as well. The nurse may become the major care-giver and resource person for increasingly high-risk clients treated in the home and their families and may become more responsible for primary prevention in wellness and health maintenance. Therapeutic communication tech-niques and skills are essential to successful management of clients in the community.
Caring for older adults in the family unit and in com-munities today is a major nursing concern and responsi-bility. It is important to assess the relationships of family members; identifying their areas of agreement and conflict can greatly affect the care of clients. To be responsive to the needs of these clients and their families for support and caring, the nurse must communicate and relate to clients and establish a therapeutic relationship.
When practicing in the community, the nurse needs self-awareness and knowledge about cultural differences. When the nurse enters the home of a client, the nurse is the outsider and must learn to negotiate the cultural context of each fam-ily by understanding their beliefs, customs, and practices and not judging them according to his or her own cultural con-text. Asking the family for help in learning about their culture demonstrates the nurse’s unconditional positive regard and genuineness. Families from other cultural backgrounds often respect nurses and health-care professionals and are quite patient and forgiving of the cultural mistakes that nurses might make as they learn different customs and behaviors.
Another reason the nurse needs to understand the health-care practices of various cultures is to make sure these practices do not hinder or alter the prescribed therapeutic regimens. Some cultural healing practices, remedies, and even dietary practices may alter the client’s immune system and may enhance or interfere with prescribed medications.
The nurse in community care is a member of the health-care team and must learn to collaborate with the client and family as well as with other health-care providers who are involved in the client’s care such as physicians, physical therapists, psychologists, and home health aides.
Working with several people at one time rather than just with the client is the standard in community care. Self-awareness and sensitivity to the beliefs, behaviors, and feelings of others are paramount to the successful care of clients in the community setting.
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