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.
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.
Delivery of nursing care to improve health of an entire community - bigger picture, deals with prevention and population at systems level.
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.
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.
Collaboration and consultation
Controlled PT compliance
Community Health Nursing
Familiar and comfortable environment for PT
Routine more determined by PT
Autonomy, choice in HC decisions for PT by PT
"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
Greek origins. R/t Maslow's hierarchy of needs.
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
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?
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.
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
Population - upstream
Public health wheel
For selling health messages
Levels of Prevention
Stay well and avoid problem
Reduction of risk factors before occurrence of disease condition/injury
E.g., exercise, brushing teeth, condoms, immunizations, nutrition.
Early detection of potential for disease/condition or existence of such while asymptomatic.
E.g., screening programs - Pap smears, mammograms, colonoscopy.
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.
Ensuring healthy populations
Appropriate and accessible services for all
Healthful physical environment
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
Diagnosis (written in different format for the community)
Gaining entry (Kauffman's 5 phases)
Kauffman's Five Phases
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.
Secondary analysis of existing data
Risk of X
Among X group/population
Planning and Prioritization Phase
Priorities established (set by community members)
Goals and objectives IDed
Community focused interventions
Role of community health nurse
Social change, community action
formative - changes made during process
summative - at end, related to outcomes
"The pedagogy of the oppressed"
Community empowerment (WHO)
Community as partner model (Betty Neuman)
Community as Partner
8 interacting community subsystems
Normal line of defense LOD = status quo
Flexible line of defense - protection vs stressors
Lines of resistance LOR - strengths, resources, coping mechanisms
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
Steps in Teaching/Learning Process
Development of outcomes
Development of teaching plan
Implementation of teaching plan
Evaluation of outcomes (did it work?)
Learning should be positive
Start simple, go to complex
Generalize and pace appropriately
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
Nature of learning
CAP = B F D
memory, recognition, understanding, application, problem solving.
attitudes, values:appreciates, chooses, accepts - role play, talk to s.o., feelings.
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