There is still some confusion as to how the nursing role in a clinical setting versus a public health nursing specialist differs. Some use the term interchangeably thus add to the confusion not only with the meaning but also to the role of each nurse performs. As both roles have a similar function in providing assessment, care, and education while also advocating for their patients. They are different in a way that public health nursing specialist is concerned with the overall health of the public population (think of larger-scale). For example, if there is an outbreak of a certain disease. Public health nurses are the ones assessing and intervening. While the clinical nurse is specific to a population’s specific needs i.e. individualize care in an acute setting, hospice setting, home care setting, etc.
In Mrs. B’s case, a clinical nurse like a case manager can help with post-acute care. Two options can be presented to Mrs. B and her family for the continuum of her care upon utilization review/discharge planning. Some factors need to be addressed when planning the discharge of Mrs. B’s preference. Depending on her baseline function after the CVA and the recommendation of the physical and occupational therapists, the first option will be a referral with rehabilitation centers hospital, since her family resides out of town. If Mrs. B’s family wants to be fully involved in her plan of care, the first of the question that needed to be addressed would be the willingness of the family to take care of the patient at their own home. The other option would be bringing her close to where Mrs. B’s family lives so they can visit her and be involved in her care. Once there’s a definite answer to the possible location of where Mrs. B would go, then as a case manager, looking for a referral that is within her insurance coverage will be ideal. If the family decided to take her in, then a home health nurse can be ordered for education, evaluation, and support. In addition to placement, medication, medical appointments, transportation to medical appointments, and therapy should be included in the plan of care.
The chosen strategies for Mrs. B are based on the public health seventeen-intervention wheel. Caring for a CVA patient post-injury is a task that requires a collaborative effort of the interdisciplinary team. But the initial and most important treatment begins during the acute phase. According to the United States Agency for Health Care Research and Quality (2015) “because stroke survivors often have complex rehabilitation needs, progress and recovery are different for each person. This first step includes helping the patient survive, preventing another stroke, and taking care of any other medical problems” (p. 2). Therefore, health teaching for the patient and family will be one of the recommended interventions that can be utilized in the 17-intervention wheel. Another practice would be collaboration. “A multidisciplinary inpatient rehabilitation setting may help people with stroke recognize and respond to immediate and forthcoming challenges, adopt strategies to manage their condition, and provide a model for increasing functional activity” (Bennett, Callender, Driver, Gillespie, Kapoor, Patterson, Priyanka, Swank, & Trammell, 2020, p. 2). Last, an earlier post-CVA patient returning to the community needs support and encouragement because sometimes the injury for CVA patients can last a lifetime.
Overall, the seventh Caritas process: share teaching and learning that addresses the individual needs and comprehension style and the ninth Caritas process: 9: assisting with basic needs as sacred acts, touching mind/body/spirit of others; sustaining human dignity would be an appropriate Caritas practice that can be used for patient that has CVA. Integrating the seventh and ninth Caritas process is ideal or CVA patients and their families because it provides a good stroke education at the same time meeting the emotional or spiritual needs of the patients and family.
