Advertisement Upgrade to remove ads

Community Health Nursing. Spring 2012. Dr Susan Lombardo, Dr Michelle Eaton.

Community

Group of people sharing something, interacting with one another. May exhibit commitment with one another and may share geographic boundary. E.g., a NORC, a school, NYU students.

Population

Group of people having at least one thing in common and who may or may not interact with one another. E.g., night-shift workers, children with CF.

Community-focused nursing

Delivery of nursing care to improve health of an entire community - bigger picture, deals with prevention and population at systems level.

Community-based nursing

Nursing care provided outside of acute care setting. Care for families, individuals within a community. At individual, "hands on" level. Does not require public health background.

Population-focused care

Interventions for health promotion, disease prevention to shape a community's overall health status.

Public health nursing

Promotion and protection of health of populations using knowledge from nursing, social and public health sciences. Population-focused; goals: promotion of health and prevention of disability and disease by creating conditions in which people can be healthy.

Acute Care

Provider control
Predictable routine
Hospital policy
Resources available
Collaboration and consultation
Controlled PT compliance
Standardized care

Community Health Nursing

Familiar and comfortable environment for PT
Routine more determined by PT
Diverse resources
Autonomy, choice in HC decisions for PT by PT

Health

"extent to which an individual or group is able on the one hand, to realize aspirations and satisfy needs; and on the other hand, to change or cope with the environment." WHO

Eudaimonistic Model

HOLISTIC
UPSTREAM
Greek origins. R/t Maslow's hierarchy of needs.
MOST HOLISTIC
Health = actualization/realization of complete fulfillment and development. Illness impedes/prevents self-actualization.
Aim to redirect thinking away from mechanistic view toward holistic view.
HOLISM, UNITY, INDIVIDUALITY

Adaptive Model

ABLE TO ADAPT
Medicine beyond treatment of disease: from writings of Dubos.
Health means ability to adapt to a changing environment. Disease is failure to adapt.
How flexible is someone in a changing environment?

Role-performance Model

ABLE TO DO JOB
Medical sociology, work of Parsons.
Person is healthy if they can perform their job.
Shapes health policies of military, industry.
Limited since one person may have many roles.

Clinical Model

MOST LIMITING
DOWNSTREAM
Health extreme = absence of S/S of disease/disability as IDed by medical science
This model = downstream pattern of thinking rather than upstream which is holistic.

Levels of Care

Individual - downstream
Family
Community
Population - upstream

Public health wheel

For selling health messages
R/t epidemiology

Levels of Prevention

Primary
Secondary
Tertiary

Primary Prevention

PREVENTION
Stay well and avoid problem
Reduction of risk factors before occurrence of disease condition/injury
E.g., exercise, brushing teeth, condoms, immunizations, nutrition.

Secondary Prevention

PREVENTION/MAINTENANCE
SCREENINGS/EARLY DX
Early detection of potential for disease/condition or existence of such while asymptomatic.
E.g., screening programs - Pap smears, mammograms, colonoscopy.

Tertiary Prevention

RESTORATIVE
Treatment of existing or symptomatic disease to prevent/delay progress.
Treatment after Dx, e.g, cardiac/stroke rehab.

Healthy People 2020

New topic areas:
adolescent health, blood, dementias inc. AD, early/mid childhood, genomics, global health, HAIs, health related QoL and well being, LGBT health, older adults, preparedness, sleep, social determinants.
"Prevention Agenda for the Nation"

Public Health Nursing

Promoting, protecting health of populations using knowledge from nursing, social and public health sciences. Population focused.

Public Health Nursing Goals

Promotion of health and prevention of disease and disability for all through creation of conditions in which people can be healthy.

Assurance

Ensuring healthy populations
Appropriate and accessible services for all
Healthful physical environment
Stable ecosystem
Strong, supportive, non exploitive membership
Extensive participation in decision making
Members' basic needs provided for.
Access to resources and opportunities for interaction
Sustainable vital economy
Maintain connectedness with cultural and biological heritages
Provide governance structures that promote health.

Community health work

unstructured, "bigger picture", community is both client and partner, work at every level but especially advocate for primary level with population focus.

Newest Vital Sign

Health literacy test: being able to read food labels.

Nursing Process in the community

ADPIE:
Assessment
Diagnosis (written in different format for the community)
Planning
Implementation
Evaluation

Community Assessment

Population assessment
Primary informants
Gaining entry (Kauffman's 5 phases)

Kauffman's Five Phases

IBSBC
Impressing
Behaving - building rapport
Swapping - sharing information
Belonging - becoming part of the group
Chilling out - near end of relationship, beginning longer term partnership with the community.

Collecting data

IOSFCW
7 methods
Informant interviews
Observation
Secondary analysis of existing data
Focus groups
Community forums
Windshield surveys

Community Diagnosis

Risk of X
Among X group/population

Planning and Prioritization Phase

Priorities established (set by community members)
Goals and objectives IDed
Community focused interventions

Implementation Phase

Action phase
Role of community health nurse
Social change, community action

Evaluation

formative - changes made during process
summative - at end, related to outcomes

Health education

"The pedagogy of the oppressed"
Community empowerment (WHO)
Community as partner model (Betty Neuman)

Community as Partner

Community core
8 interacting community subsystems
Community stressors/boundaries
Normal line of defense LOD = status quo
Flexible line of defense - protection vs stressors
Lines of resistance LOR - strengths, resources, coping mechanisms

Health Education

Planned learning experiences based on sound theories to provide individuals, groups, communities opportunity to learn info and skills to make quality health decisions

Health Education Goals

Help individuals, groups, communities achieve, by own actions/initiative, optimal health
Facilitate voluntary actions to promote health
Empowerment
Advocacy
Self-efficacy

Steps in Teaching/Learning Process

ADDIE
Assessment
Development of outcomes
Development of teaching plan
Implementation of teaching plan
Evaluation of outcomes (did it work?)

Facilitate learning

Stimulate senses
Active learning
Comfortable
Learner's readiness?
Relevant information
Repetition
Learning should be positive
Start simple, go to complex
Generalize and pace appropriately

Transtheoretical Model

Most common learning theory
Stages of Change
Precontemplation - resistance; don't see problem
Contemplation - know there's a problem and thinking about it
Preparation - decision making; prepared for action, e.g., cutting down on cigarettes.
Action - modifies behavior/environment to overcome problem. Takes lots of time and energy. W/D S/S now.
Maintenance - constant work to avoid relapse.

Transtheoretical Model: Stages of Change

PCPAM
Precontemplation
Contemplation
Preparation
Action
Maintenance

Nature of learning

CAP = B F D
Cognitive Domain
Affective Domain
Psychomotor Domain

Cognitive Domain

BRAIN
memory, recognition, understanding, application, problem solving.

Affective Domain

FEELINGS
attitudes, values:appreciates, chooses, accepts - role play, talk to s.o., feelings.

Psychomotor Domain

DEMONSTRATE
Hands on manipulation, "teach back"
performance of skills requiring coordination and motor skills.

Planning health education

Establish outcomes - measurable
Mutual goal setting with community as client

Educational objectives

Cognitive
Affective
Psychomotor

Please allow access to your computer’s microphone to use Voice Recording.

Having trouble? Click here for help.

We can’t access your microphone!

Click the icon above to update your browser permissions above and try again

Example:

Reload the page to try again!

Reload

Press Cmd-0 to reset your zoom

Press Ctrl-0 to reset your zoom

It looks like your browser might be zoomed in or out. Your browser needs to be zoomed to a normal size to record audio.

Please upgrade Flash or install Chrome
to use Voice Recording.

For more help, see our troubleshooting page.

Your microphone is muted

For help fixing this issue, see this FAQ.

Star this term

You can study starred terms together

NEW! Voice Recording

Create Set