Community Nursing Reflective Essay

My current nursing path is leading me down community nursing therefore the research article gave me an insight on areas to focus to assist my patients to remain in the homes. As a student nurse, I found the OASIS assessment difficult to understand and I can see where true compliance may be difficult. Also, the documentation is only as good as those doing the assessment. I would not think that any professional would assess a client as at risk for fall and then note that they did not do anything to combat this risk. With many factors, both positive and negative, contributing to the outcome of care in the home setting, I can see where it is hard to create a model of care that works for everyone, but assessment of those with are at increased risk for poor outcomes, is one step towards reducing the readmission rate for those in the high risk age group of 65 and over. The material and items included in the OASIS assessment and the criteria of the Transitional Care Model are a good basis to help flag those patients that are at higher risk for readmission. The TCM use of an APN is holistic approach since part of the issue with home maintenance is connecting all of the different sources of care that a patient receives. It’s applying the upstream thinking …show more content…
It would be like expecting to cure all diseases. However, just like we keep working to come up with better ways to treat diseases and injuries in the hospital setting, we keep working on decreasing the rate of readmission. There is a lot the nursing profession can do, it not just about the acute care of the patient, it’s about keeping them from returning to the hospital setting. Follow-up, assess for risk factors, communicate or just hear our patients. Maybe that is why I have such a passion for nursing and I believe in all that we are taught on the proper way to take care of patients. Giving them not just quantity of life, but quality of