ambulatory care week 1

N6330 Intro to Ambulatory Care Nursing Fall 2025

Instructor Information

• Instructor: Ana Maria Kelly, PhD, RN, FAAN
• Institution: Columbia University School of Nursing
• Course Focus: Healthcare outside the hospital

Lesson Objectives

• Pro Tip: Use weekly lesson objectives as study guide questions for the exam (Approximately 5 Questions on Exam 1)
  1. Differentiate acute care from ambulatory care by:
  • Setting
  • Roles and responsibilities
  • Goals
  1. Identify unique attributes of public health nursing compared to ambulatory or community health nursing.
  2. Define "population" in the context of population health.
  3. Match examples of care to the correct payer (Medicaid, Medicare A, and Medicare B).
  4. Differentiate screening from surveillance.
  5. Within the role of the home care nurse:
  • Distinguish skilled nursing care from nurse aide role.
  • Identify priority concerns.
  1. Identify the goal, process, and main challenge of conducting a community assessment.

Understanding Ambulatory Care

• Definition: Healthcare offered outside of the acute care setting (outpatient care).
  • Scope: Broader term encompassing unique communities, populations, and the public health sector.
  • Course Integration: Combination of Community Health, Population Health, and Public Health under the term Ambulatory Care.
• Implications for Graduates:
  • Opportunity to provide holistic patient care by understanding community vulnerabilities and post-hospital condition management.
  • Continued service as an RN outside of hospitals in various capacities (e.g., volunteering, emergency response).

U.S. Bureau of Labor Statistics on Registered Nurses

• Median Pay (2024):
  • Annual: $93,600
  • Hourly: $45.00
• Typical Entry-Level Education: Bachelor's degree.
• Work Experience: None required.
• Number of Jobs in 2024: 3,391,000.
• Job Outlook (2024-34): 5% increase (faster than average).

Employment Distribution of Registered Nurses (2024)

• Hospitals: 59%
• Ambulatory Healthcare Services: 19%
• Nursing and Residential Care Facilities: 6%
• Government (excluding education and hospitals): 5%
• Educational Services: 3%

Ambulatory Healthcare Services

• Includes:
  • Physicians' offices
  • Home healthcare
  • Outpatient care centers

Roles and Definition of Ambulatory Care Nursing

Overview of Ambulatory Care Nursing (American Academy of Ambulatory Care Nursing)

• Field Focus: Specialized care in outpatient settings.
  • Supports individuals, families, and communities across stages of life.
  • Critical role in primary and specialty care without the necessity of hospitalization.
• Core Functions:
  • Collaboration, education, and care management to empower patients in preventing illness, managing chronic conditions, and achieving better health outcomes.
  • Service includes both in-person and virtual care to meet patient needs.

Distinction from Public Health Nursing (Association of Public Health Nurses)

• Definition: Promotion and protection of population health using knowledge from nursing and public health sciences.
• Objective: Focus on population health to prevent disease and disability via systematic outreach and policy development.
• Role Context: Public Health Nurses serve diverse community roles and encompass different settings, including health departments and schools.

Key Distinctions in Health Focus

1. Ambulatory Care: Focus on treatment of individuals (sick care).
2. Public Health: Emphasis on disease prevention and health promotion across entire populations.

Definitions and Differences in Health Terminology

Population in Population Health

• Definition: Group of individuals defined by a geographic area or shared characteristics (e.g., ethnicity, age).
• Comparison of Community vs. Population:
  • Community typically refers to local characteristics.
  • Population implies a broader scope.

Examples for Understanding:

• Substance Use among Adolescents in Astoria, Queens (Population)
• Mortality Rate in the State of New York (Population)

Screening vs. Surveillance in Public Health

Definitions:

• Screening: Testing a group at a specific time.
• Surveillance: Ongoing, broader data collection and analysis.

Example Scenario:

• Surveillance: Data collection on MRSA cases by health department.
• Screening: Local nursing home administering MRSA swab testing.

Role and Focus of the Ambulatory Care Nurse

Task Focus (Based on AAACN RN Role Position Paper, 2023)

• Upstream Prevention: Addressing root causes of health issues.
• Primary and Specialty Services: Involves outpatient specialties such as cardiology, neurology, etc.
• Health Disparities: Understanding differences in health among groups due to social determinants.
• Patient Education: Reviewing discharge instructions and enhancing self-care.
• Effective Communication & Care Transitions: Ensuring smooth transfers from inpatient to outpatient.
• Nurse-Sensitive Indicators: Focus on metrics like fall prevention and infection control.

Course Schedule Overview

Comparison of Ambulatory Care and Acute Care

Ambulatory Care Nurse Goals

• Goal: Promote client independence or self-determination through:
  1. Assessment-Based Approach:
  • Identify client strengths, assess readiness, evaluate support systems, recognize barriers to independence.
  1. Education and Skill Building:
  • Health literacy and self-care training including medication management.
  1. Resource Connection and Advocacy:
  • Navigating healthcare systems and connecting clients to community resources.
  1. Empowerment Strategies:
  • Collaborative goal-setting and encouraging self-advocacy.
  1. Environmental Modifications:
  • Home safety assessments and access to assistive technology.

Career Corner: Home Healthcare Nursing

Discussion Topics

• Role Description: Skilled nursing provided in-home versus nurse aid responsibilities.
  • Benefits of home care include longer education opportunities, comfort, and logistical support for patients.
• Day-to-Day Responsibilities: Autonomy and flexibility in scheduling.
• Safety Concerns: For both patients and nurses in home health care contexts.

Payment Sources for Home Care Nurses

• Personal Sources: Savings, retirement funds, home equity.
• Insurance: Long-term care insurance.
• Government Assistance: Medicare, Medicaid, Veterans Affairs.

Coverage Overview

• Generally, insurance covers provider-prescribed skilled nursing care outside the hospital, with specifics varying by coverage levels. Medicaid often has broader benefits for nonmedical personal care.

Common Roles in Home Care Nursing

Managing Chronic Diseases

• Examples include:
  1. ALS
  2. MS
  3. Post-CVA
  4. Parkinson's
  5. Alzheimer’s
  6. Traumatic Brain Injury (TBI)
  7. Tracheostomy/Ventilator care

Managing Acute Conditions

• Examples include:
  1. Wound care
  2. IV administration and titration
  3. Post-surgical care

Example Home-Based Care Programs from NYC Department of Health

1. NYC Nurse-Family Partnership:
   • Free home visiting program for low-income, first-time mothers.
   • Supports healthy pregnancies and child development.
2. Healthy Homes Program:
   • Addresses issues like mold in homes of patients with asthma to improve health outcomes.

Readmission Data Overview

Rate of Hospital Readmission by Diagnosis Category (2020)

• Highlighted principal diagnoses include:
  • Endocrine and metabolic diseases: 23.8% readmission
  • Mental health disorders: 17.0% readmission
  • Circulatory diseases: 15.3% readmission
• U.S. ED Visits: Approximately 150 million annually (CDC).

Impact of Ambulatory Care Nursing on ER Readmission Rates

• Effective nursing-led care coordination impacts the CMS Hospital Readmissions Reduction Program.

Definitions of Medicare and Medicaid

• Medicare: Federal health insurance for individuals aged 65+ and certain younger individuals with disabilities.
• Medicaid: State-run program assisting low-income individuals, jointly funded by federal and state resources.

Parts of Medicare

1. Part A: Cover inpatient hospital care and limited home health care.
2. Part B: Covers outpatient care, including necessary doctor services and some preventive services.
3. Part C (Medicare Advantage): Combines coverage from Part A and B with additional benefits.
4. Part D: Assists with prescription drug costs.

Guidelines for Political Discussions in Class

1. Acknowledge diverse backgrounds and value systems.
2. Use factual data and cite sources during discussions.
3. Foster a cooperative environment towards improving patient health outcomes.

Overview of Public Health Institutions

• CDC: Focuses on disease prevention and health promotion since 1946.
• WHO: Formed post-WWII to tackle global health issues, now addressing a wide range of health concerns.

Key Public Health Leaders

1. Surgeon General: Chief public health spokesperson in the U.S.
2. HHS Secretary: Advisor on public health matters, leading critical public health agencies (e.g., CDC, FDA).

Community Assessment Assignment Overview

Purpose

• Core tool for community health nurses to assess community health and identify needs.

Key Tasks include:

1. Collecting primary and secondary community data:
   • Windshield Surveys
   • Informant Interviews
   • Focus Groups
2. Disease Registries and Vital Statistics.

Windshield Survey Overview

• Initial assessment style for community health.
• Observations on transportation, housing, local businesses, and health facilities.
• Assess neighborhood demographics and service availability.

Practice Questions and Answers

Sample Questions:

1. Public health nurse monitors health trends in a district; best describes it as:
   • Answer: B. Surveillance.
2. For a home health nurse caring for a Parkinson's patient, primary advocacy goal is:
   • Answer: Client independence.
3. Transition from acute care to home health will require:
   • Considering autonomy and flexibility of the work environment.
4. Focus on asthma prevalence in community demonstrates:
   • A population-oriented focus.
5. Population is defined as:
   • Defined by geographic location or demographics.

Answer Rationale:

• Surveillance involves ongoing monitoring.
• Client independence reflects the core focus of community nursing.
• Home health settings enhance assessment of environmental health determinants.
• Population assessments require broader generalizations rather than individualized care.