The community nursing service is a special form of healthcare carried out at patients’ homes, in primary health care centres, local communities and in the field. The method and place of operation make the community nursing service the part of primary healthcare that is the quickest in recognising social changes and that can also rapidly and effectively respond to these changes. The registered nurses of the community nursing service (hereinafter: community nurses) care for individuals, their family and community in the environment where they live, learn, play and work. They actively care for the health condition of people living in a certain area, develop health promotion programmes and encourage people in their care to take best possible care of their own health and the health of their families. In-depth individual and family care is mostly required for priority groups classified as such due to their biological characteristics (e.g. babies, schoolchildren, pregnant women, elderly), changed living conditions, social risk (immigrants, homeless) and health risk (disabled, chronic patients), and other vulnerable groups.
Community nurses are the only providers in the healthcare system whose workplace is in patients’ homes and in local communities. They care for individuals and their families in all life stages and events, including the period of grieving the death of a family member. The framework for ensuring quality preventive healthcare for persons in the care of the community nursing service is laid down in the Rules on carrying out preventive healthcare at the primary level.
Community nurses are independent in planning their work. In the implementation of the diagnostic and therapeutic programme within nursing care at home they cooperate with specialist doctors. Their advantage lies in an exceptional knowledge of the population in their assigned area, where they identify social and medical problems and seek solutions also by connecting with the local community and non-governmental organisations. This provides appropriate conditions for individuals to stay in their home environment as long as possible, despite old age, illness or frailty. Community nurses are coordinators of all types of home help, and a link between a person and their selected doctor.
The planned upgrade of community nursing activities includes:
- the care of newborns, infants and neonatal mothers at home under the updated programme,
- analysis of the assigned areas of individual community nurses,
- counselling service provided by community nurses in local communities, and
- the establishment of contacts between community nurses and persons who do not respond to invitations to undergo preventive health checks in a family medicine clinic, finding the reasons for non-responsiveness and taking action according to the reason found.
The updated programme is intended to provide equal preventive care at home to all neonatal mothers and infants up to one year of age. A community nurse makes eight preventive home visits of a neonatal mother and her child within the child’s first year.
The nurse makes two visits within the first six weeks of birth. The first visit is within 24 hours of arrival from the maternity hospital and the subsequent three are within the child’s first month.
The visits in the infant’s fourth and sixth months are intended to provide support to parents in recognising the infant’s healthy physical, emotional and speech development, to give advice on introducing solid food and information on teeth development and dental hygiene, to talk about the functioning of a family, to raise awareness of the importance of reading, and to address other important topics.
The last visit is usually made when the infant is ten to eleven months old to check the child’s growth and development, provide guidelines on childcare after child nursing and care leave ends and on the safety of the child at home and outside, raise awareness of the importance of the child’s socialisation and discuss other relevant topics. In order to prevent injuries in the home environment, a community nurse checks the safety of the home following the “Check if your home is safe for a baby” checklist. A community nurse gives the checklist to parents upon the first visit and later they can check the safety of their home together with the nurse. During such safety inspection, a community nurse can give a neonatal mother additional explanations and advice.
The programme envisages the application of special procedures and tools for identifying and caring for particularly vulnerable groups of neonatal mothers and newborns at home. One of the new elements is determining the vulnerability of a neonatal mother, child or family, with regard to which a community nurse may make additionally two to five preventive visits, depending on the fulfilment of the vulnerability criteria. The visits are made in a provisionally determined period according to the type of vulnerability or the professional assessment of a community nurse.
A common problem of women after giving birth is postnatal depression, which according to experts is caused by hormonal changes. It develops in 10–20% of neonatal mothers. In order to detect any signs of postnatal depression in time, when visiting a neonatal mother a community nurse carries out a screening test using the EPDS (Edinburgh Postnatal Depression Scale) questionnaire, which facilitates the identification of postnatal depression signs. Normally, the questionnaire is used on the visit in the fourth to sixth week after childbirth.
The fundamental method of work of community nursing is field work in a geographically defined area involving family patient care in all life stages and in the patients’ home environment. The work of the community nursing service is focused on treating the area as a whole, while also considering individual persons, families and communities in their living environment. A community nurse knows:
- the key demographic features of the population,
- their health and social status,
- the local characteristics that affect the health of the population,
- the services guaranteed to the population,
- the local and national priorities concerning health and other areas.
An analysis of the nurse’s assigned area consists of a description of the area, the analysis of work performed, proposed measures and a plan for carrying out the programmed preventive community nursing for each community nurse. On the basis of the analyses of nurses’ assigned areas and annual plans prepared by community nurses, the head of the community nursing service of a healthcare institution prepares a common document (also covering the areas of private nurses with concessions) compiling key findings and measure proposals, and draws up the plan of cooperation and integration with other stakeholders. This document is included in the documents of the healthcare institution as appropriate.
By providing health promotion counselling services in a local community according to the agreed schedule, a community nurse additionally contributes to the inclusion of vulnerable groups in preventive healthcare and to the promotion of health in the local community. Once a week a community nurse is present “somewhere” in the assigned area which is not always in the same place. A community nurse provides counselling services within towns/city districts in the assigned area by prior agreement. The counselling is intended for vulnerable groups or prevalent health issues in the local environment. Within counselling services a community nurse may conduct individual counselling (e.g. help in choosing the selected doctor, paediatrician, gynaecologist or dentist; help for victims of violence), assist in arranging the compulsory health insurance, present the workshops of IHPCs and refer to them, conduct measurements, give short lectures (e.g. on vaccination against influenza or tick-borne meningoencephalitis, breast self-exams, sun protection) and short workshops (in cooperation with providers of the standard team of the IHPC). A community nurse also participates in presentations in the local community (independently, together with the providers of the standard team of the health promotion centre, with representatives of the National Institute of Public Health, etc.).
A graduate nurse of a family medicine clinic invites individuals above 30 years of age to undergo preventive health checks. If a person does not respond after three invitations, the nurse from the family medicine clinic informs the community nurse thereof. The latter contacts the person concerned within two weeks, finds the reason for unresponsiveness and acts accordingly. Most frequently the action is related to finding ways to motivate the person to respond to the invitation and undergo a preventive health check in the family medicine clinic or to conducting a preventive health check at home.
When entering a family, a community nurse checks if all the family members qualifying for a preventive health check have undergone such a check. If necessary, the nurse helps arrange the appointment for a preventive health check or conducts a preventive health check. A community nurse may conduct a preventive health check at home for vulnerable persons who are unable to visit a family medicine clinic (persons with disabilities, persons with mental health disorders, geographically remote persons, migrants, etc.). If it is established that a person is exposed to risk factors or is at risk of developing or has signs of a chronic non-communicable disease or condition, a community nurse refers the person to a IHPC or provides appropriate care. The nurse reports the findings to the person’s selected doctor. The nurse includes the person in the care programme that is most suitable with regard to the situation established. Relatives and other relevant persons are also included in the care programme, particularly if the nurse believes that this would help in understanding the content and thus effectiveness of preventive care.
In accordance with a specified algorithm, a community nurse conducts preventive health checks of persons who due to their vulnerability are unable to visit a family medicine clinic and are in the nurse’s assigned area. For patients who have already been diagnosed with a chronic non-communicable disease a community nurse conducts screenings for particular risk factors. The community nursing questionnaires for preventive health checks concerning chronic non-communicable diseases include the APGAR questionnaire and the questionnaire “Family and family problems” which facilitate comprehensive family care. The upgrade of community nursing includes the assessment of factors posing a risk of fall and prevention of falls for persons older than 64 at their homes, on the basis of the “Check if your home is safe” checklist intended to identify risks the older persons might not have known about.
By carrying out the upgraded preventive activities and additional activities, community nurses actively contribute to the reduction of health inequality, facilitate the inclusion of vulnerable persons in preventive care and promote health in the local community.