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What is community health nursing mean today?
used to describe health promotion and disease prevention among groups of people
What was community health nursing in the past?
What terms are used interchangable to described community nursing?
- public health
- community health
T/F Most nurses who work in traditional public health roles today do in fact work for government operated public health programs or agencies?
What are common variables between those working in traditional public health roles, and those working in what is described today as community
- 1). Care is provided outside of an
- institutional healthcare setting (such as a hospital, nursing home, etc.)
- 2). The focus of care is health promotion, maintenance and disease prevention among a specific group of
health of a specific (county) or state
public health unit or department community health nursing setting
health of children enrolled in a specific school
school community health practice setting
health of members of a specific fatih congregation
faith congregation community health practice setting
health of employees of a specific worksite
work community health practice setting
health of those incarcerated in a specific prison
prison community health practice setting
What are some examples of community health practice settings?
- public health unit or department
- faith congregation
- home health/hospice
These community health nurses focus is a specific group of individuals and their families within the general population in which they practice.
home health/hospice community health practice setting
What is the focus of home health nurse?
The focus of care by home health nurses is an individual recovering from an acute disease or illness, or an individual learning how to live with and manage a chronic or long-term disease.
What do hospice nurses do and what is their focus? What about family members of hospice patients?
- Hospice nurses work with individuals with a terminal disease who are not expected to live longer than six months.
- The focus of care is on comfort measures and ensuring the patient has a peaceful death.
- The family of the individual is also considered to be the client in both home health and hospice care.
- Family members are often the recipients of teaching or instruction in how to care for the recovering or terminally ill patient.
According to the Quad Council of Public Health Nursing Organizations (1999), Public health nursing is defined as:
- “Public health nursing is the practice of promoting and protecting
- the health of populations using knowledge from nursing, social, and public health sciences.”
WHY ARE COMMUNITY HEALTH COURSES TAUGHT WITHIN THE SLU
SCHOOL OF NURSING CURRICULUM?
- It is anticipated that 4 the greatest need for registered nurses in the future will be in community-based settings
- In order to meet society’s need for registered nurses who can practice in both community-based and institutional-based settings, the SLU School of Nursing emphasizes experiences in both settings throughout the curriculum
- Regardless of where you eventually practice nursing, your clients will be part of a larger community, and their health will directly be impacted by issues within that community
health issues within
the community ultimately impact registered nurses in all practice settings on some level
What is an example of a community health issue facing Baton Rouge?
- high incidence of HIV infections within the community
- RN's in Baton Rouge are likely to encounter patients with HIV in any setting they practice in
This corse will help you begin developing the knowledge and skills that you will need to function in the diverse community practice settings of the future.
Why did public health nursing develop?
- out of concern with events surrounding birth, death, and illness
- Early humans lived in small tribal units, but as the human population grew, man moved from place to place and interacted with a larger number of people.
- Communal living, both in small and large groups, creates health problems. Because of this, humans have always had a desire to understand, prevent, and control disease, but this need became more and more pronounced
- as the population grew.
- Simply defined, public health seeks to prevent, eliminate and/or minimize, and treat health problems
When did public health begin as a formal discipline?
- Renaissance Period (14th - 16th centuries).
- During this time period advances in scientific inquiry occurred.
- A greater knowledge of anatomy, physiology, and other scientific processes greatly bolstered the understanding of disease and illness, as well as prevention and treatment
Public health nursing was greatly influenced by what in the twentieth century?
- advances in medicine and technology
- Data collection and analysis is critical to public health practice, and computers make working with data more efficient
What are the 4 focuses of public health nursing today?
- 1). the promotion of health,
- 2). the prevention of disease
- 3). the provision of health care services, 4). Rehabilitation from illness and/or disability
In order to achieve the 4 objectives of public health nursing today, practitioners must regularly engage in what 3 core functions?
- regularly and systematically assessing the community to identify needs
- developing policies to address the
- assuring that necessary services are available to meet the needs of the community.
How did public health nursing get to where it is today?
Following are several historical milestones that have lead to our practice of modern public/community health.
What historical milestone in public health occurred during Early Civilization?
- In 400 B.C. Hippocrates wrote about the influence of the environment, diet, and work, on health and disease.
- He is credited with being one of the earliest people to clearly document
- these relationships.
- Another early source of information on the link between cleanliness 6
- (hygiene) and diet on health is the Hebrew writings on dietary and hygiene laws found in the Old Testament.
- The Greeks contributed much to the early development of public health.
- In 500 B.C. the Greeks documented the first communicable disease on record - malaria.
- The Greek culture promoted cleanliness and sanitation, and these values were reflected in Greek
- Hygeia was the goddess of health and Panacea was the restorer of health. The Egyptians were also important in the early development of public health and by 1000 B.C. had developed pharmaceuticals and public sewer systems.
What historical milestones in public health occurred during the early christian/roman era?
- The Romans are given credit for the early development of public sewers and aqueducts, both of which contributed to environmental
- cleanliness and hygiene.
- The Romans were also the first to write about worker's health, specifically miners and the quality of air in mines.
- The Romans eventually adopted the Christian religion, and Christianity promoted a caring social/community perspective that evolved from the Christian doctrine of "love thy
- This belief is reflected in the Christian parable of "the good Samaritan."
- The Romans were also the first to developed hospitals and homes for the sick.
- Two Christian women in Rome, Fabiola and Paula, both established hospitals
What historical milestones in public health occurred during the middle ages?
- During the middle ages the Roman Empire declined, as well as its values of health and hygiene.
- Poor sanitation and hygiene practices developed, and epidemics such as influenza, smallpox, and the bubonic plague spread across the European continent.
- However, a connection between religion and health remained, and monasteries and convents began
- providing care for the sick.
- Military nursing orders (which by the way were primarily composed of men – not women) developed during The Crusades (or “Holy Wars” – so much
- 7 for that kind, compassionate, Christian perspective of love they neighbor!!!)
What historical milestones occurred during the Renaissance?
- During the Renaissance there was a return to the values of human dignity and worth.
- Scientific inquiry expanded, universities were established, and dissection of the dead became
- Statistical data began to be collected on the causes of death, and this was the beginning of the fields of public health and epidemiology.
- Towns also began adopting
- cleanliness or sanitation rules, and formal training programs were developed for physicians
What occurred during the sanitary movement?
- Edward Jenner (1749-1823) discovered the smallpox vaccination, and in 1853 inoculation for smallpox became compulsory in England.
- This was the first required mass vaccination for an infectious disease.
- Louis Pasteur (1822-1895) introduced the "germ theory" of disease.
- Joseph Lister instituted surgical asepsis techniques using carbolic acid (phenol) to spray the surgery room, clean the surgical instruments and wash the hands of the surgeon.
- Prior to this (and even after for quite some time) cleaning the surgical room, table and instruments between patients was not a common practice! The surgeon washing his hands between patients was unthinkable – too much valuable time would be wasted
discovered the smallpox vaccination
What was the first required mass vaccination for an infectiour disease?
the smallpox vaccine discovered by Edward Jenner
Who developed the "germ theory"?
Who instituted surgical asepsis techniques using carbolic acid (phenol) to spray the surgery room, clean the surgical instruments and wash the hands of surgeons?
What occurred during the nursing training movement?
- Florence Nightingale
- Clara Barton
- Frances Root
- Lillian Wald and Mary Brewster
- Henry Street Settlement
- Met Life Insurace Company
What was Florence Nightingale's contribution to public health nursing?
- "Mother of Modern Nursing"
- first nurse epidemiologist
- kept meticulous statistics and notes on the # of patients cared for, her interventions, and the outcomes
- influenced by Pasteur's writtings and many of her nursing interventions was based on the premise that germs cause disease
- after her successes during the Crimean War, William Rathbone, provided funding for her to establish the district nursing association in Liverpool, England in 1859
Who were the district nursing association in Liverpool, England and what did they do?
This was the first formal group of public health nurses to visit the sick in their homes and work within the community
Who established the Red Cross in the U.S. in 1864?
- Clara Barton
- Barton was not a trained nurse (although she is often mistakenly given credit for being the U.S. equivalent of Florence Nightingale).
- However, the Red Cross made early attempts at providing community-based care in America
Who became the first trained nurse in the U.S. to work as a visiting nurse in 1887?
Who established the Henry Street Settlement in 1893 and why?
- Lillian Wald and Mary Brewster
- provided nursing care for the poor immigrant residents of New York City
- Nurses operated a walk-in clinic at the Henry Street Settlement House, but would also go into homes and out into the community to provide visiting nursing service
Who is credited with being the true mother of public health nursing in the United States?
Who helped the American Red Cross establish visiting nursing services in rural areas of the U.S., and in 1909 she secured payment for visiting nurses from Met Life Insurance Company?
Why was securing payments for visiting nurses from Met Life Insurance Company important?
it was the first time in history that an insurance company paid for nursing services
What historical milestones occurred during the twentieth century?
- advances in science, technology, and education during the 1900s
- shift from commuity-based nursing care to institutional-based care
- Many of the early visiting nurse programs were replaced by the building of hospitals, and hospitals became the place were people would go for care when they became ill
- labor union of the 1920s and 30s
- better record keeping of vital statistics and health data due to computers
- discovery of antibiotics in the 40simproved workplace safety-mainly due to labor union movement
- increased use of seatbelts and safer designed automobiles
- decline in cause of death from heart disease and stroke
- inspection and regulation of meats and produce lead to healthier food sources, and the fluoridation of water decreased dental diseases
What was the building of hospitals fuelded by during the twentieth century?
growth of the health care insurance industry
What did the labor union movement force employers to offer to their employees during the twentieth century?
- health insurance
- as more and more people became insured, more and more hospitals were built
T/F Many health insurance companies began employing their own visiting nurses as a cost saving measure to lengthy hospital stays in the twentieth century?
Re-emergence of the importance
of community-based nursing occurred once again at the close of the twentieth century as insurance companies looked for alternatives to lengthy hospital stays
What had the greatest impact on public health during the twentieth century?
- discover of antibiotics in 1940s
- Widespread use of immunizations to prevent diseases was also a major public health success of the twentieth century.
- Both of these helped contribute to the control of infectious diseases
What contributed to the decline in heart disease and stroke causes of death during the late twentieth century?
- due to improved medical management through the use of new medicines and technologically improved cardiovascular surgical techniques
- improvements in diet and exercise
- recognition of tobacco as a health hazard
- better family planning and pre-natal care
What factors will influence community health nursing in the 21st century?
- health care delivery system
- poverty and growing disparities
- primary health care
- violence and bioterrorism
What will influence the health care delivery system in the future?
- cost containment
- More and more health care services will be provided outside of costly institutional settings in the future.
- Technology will continue to make community-based care possible.
- Technology will enable community health nurses to assess and manage clients from remote locations.
- Such technology is already being used in pilot projects throughout the world
What effect does demographics have on the future of community health nursing practice?
- aging population due to better health care has added at least 25 years to the average life expectancy
- increasing cultural diversity-nurses need to expand their knowledge on various cultural groups and how their beliefs and values may influence individual health
What effect does globalization have on the future of community health nursing practice?
- we are all interconnected with our families, work, school and communities
- "global village" created due to the growing economic, political and technological intergration
What effect does poverty and growing disparities have on the future of community health nursing practice?
- estimated that 1.3 billion people live in poverty around the world
- The trend in the United States has been to decrease welfare support and encourage more people to return to work
- However, with the new era of globalization, many entry level jobs in the United States have been moved to third world countries where labor is cheap.
- This creates a cycle of poverty for people in the United States who no longer qualify for welfare but cannot find entry level or minimum wage jobs. Those living in poverty in all parts of the world suffer from poor environmental and living conditions, as well as inadequate nutrition
- estimated that worldwide 40,000 children die yearly from hunger-related diseases
What effect does primary health care have on the future of public health care?
- In 1978, at Alma Ata, the World Health Organization (WHO) challenged every nation to provide a basic level of health for all its citizens
- era of "health for all"
How did the WHO define primary health care?
Primary health care is essential health care; based on practical, scientifically sound, and socially acceptable methods and technology; universally accessible to all in the community through their full participation; at an affordable cost; and geared toward self-reliance and selfdetermination
What are the 8 essential elements of primary health care according to the WHO?
- 1. Education for the identification and prevention/control of prevailing health problems
- 2. Proper food supplies and nutrition
- 3. Adequate supply of safe water and basic sanitation
- 4. Maternal and child care, including family planning
- 5. Immunization against the major infectious disease; prevention and control of locally endemic diseases
- 6. Appropriate treatment of common diseases using appropriate technology
- 7. Promotion of mental health
- 8. Provision of essential drugs
Following Alma Ata, the U.S. in 1979 developed what?
Healthy People program continues to be one tool used in the United States to address the essential elements of primary health care
What influence does violence and bioterrorism have on public health nursing?
- increasing around the world
- increase in gang related violence-especially from gun shootings
- the influence of the media and entertainment on the increase in violence is unknown
- increase in domestic violence-estimated that 25-30% of all women
the use of biological agents to produce death or disease in humans, animals or plants
simply a model that is used in the field of nursing to provide direction for nursing practice; serves as guidance for research and education in the field of nursing
a conceptual representation of reality
What is the first phase of the nursing process in relation to community nursing?
- establishing a partnership or contract with a community
- determing that the community's perceived needs are and what role the nurse will plan in meeting those needs
What does the assessment phase of th enursing process related to community nursing involve?
- the nruse assesses the community through data collection
- data may be collected through interviews (subjective) or observations and public databases (objective data)
What does the diagnosis phase of the nursing process related to community nursing involve?
- data must be analyzed to determine the problem(s) within the community
- called nursing diagnosis or community health diagnosis
What does the planning phase of the nursing process related to community nursing involve?
- plan includes goals and interventions
- the goals identify the outcomes or what the community desires to achieve
- interventions are those activities that the nurse will do to help the community achieve its goals (i.e. health screenings or educational programs)
What are the 4 concepts that nursing models typically have in common?
What model is used to assess the overall health of a community and who developed the model?
- community-as-a-partner model
- Anderson and McFarland
- provides a framework for assessing a community, analyzing the data collected, identifying community health issues (diagnoses), establishing goals and interventions, and evaluating the effectiveness of the interventions
- based on Betty Neuman's total-persons approach (1972) and follows the nursing process
How is assessment represented on the community-as-a-partner model?
- assessment wheel
- the center of the wheel is referred to as the "community core"
- surrounding the community core are 8 subsystems of the community
What does the community core represent on the assessment wheel?
- represents the people that make up the community
- To assess the community core, data about the community's demographics, values, beliefs and history, are collected.
- The people (or core) of the community are affected by, and in turn influence, the eight subsystems of the community
What are the 8 subtypes that are assessed on the assessment wheel?
- physical environment
- health and social services
- politics and government
- safety and transportation
What does the solid line surrounding the assessment wheel represent?
- the community's "normal line of defense" or "level of health"
- it represents what the community normally does to maintain health
What does the broken line surrounding the assessment wheel represent?
- the community's "flexible line of defense"
- it creates a "buffer zone" protecting the community and the normal line of defense
- The flexible line of defense represents a dynamic level of health resulting from temporary actions in response to a stressor
Within the assessment wheel, the community core and eight subsystems are divided by ____ lines?
- broken lines
- These lines indicate that the eight subsystems are not isolated and separate from one another, but influence, and are influenced by, one another
What do broken circular lines within the assessment wheel represent?
- "lines of strength" or the strengths of the community
- These lines of resistance are present in all subsystems of the community and represent the defenses the community has in place to fight stressors
any stimulus that threatens the balance or equilibrium of the system
- i.e. threat of STD's
- Stressors may come from outside a community and penetrate its flexible and normal lines of defense (i.e. air pollution from an industry located in a nearby town)
- stressors may come from within a community (i.e. lack of needed services or access to needed services)
Interviewing a member of a community is considered what type of data?
collecting data through direct observation
What is the degree of reaction and what phase is this involved in?
- the amount of disequilibrium or disruption caused by the stressor.
- The degree of reaction may be reflected in assessment data, such as morbidity and mortality rates, unemployment, or crime statistics, to name a few.
- involved in the diagnosis phase
Is the degree of reaction always negative?
- as a result of a stressor (a problem or crisis) members of the community may band together and form a group to deal with the stressor.
- After the stressor has passed, or been minimized, the group may continue to function, thus strengthening the overall health of the community and becoming part of its lines of resistance or line of defense
What does the nurse do during the analysis phase of community-as-a-partner model?
creates a problems list and then from the list formulates a community health diagnosis for each problem identified as a priority for a community
What does the nurse do during the planning phase of the community-as-a-partner model?
- establishes goals with members of the community
- goals will reflect national health priorities-healthy people 2010
- then the nurse develops interventions that will help the community members achieve their goals
Intervention that aim at strengthening the community's normal line of defense so that stressors cannot penetrate it
- primary prevention
- focus on prevention
- i.e. immunizations of preschoolers
Interventions that are applied after a stressor has penetrated the community
- secondary prevention
- focus on health screenings
- i.e. breast self-exams, mammography, blood pressure screenings
Interventions that are applied after the stressor has penetrated the community
and a degree of reaction has taken place
- tertiary prevention
- aimed at preventing additional disequilibrium and promoting equilibrium
- focus on treatment
- i.e. a team of counselors
- brought in to work with students in shock following a school shooting; support groups
Where does the evaluation of the community-as-a-partner model come from in the community?
feedback from members of the community
What are some published sources of data that a nurse could use to obtain data about each of the 9 components of the community assessment wheel?
- U.S. Census Report
- Parish Health profile
- Statistics abstracts from LA
- LA Dept. of Public Health
- LA Dept. of Labor
- FBI uniform crime report
- LA Dept. of Education
What observations would a nurse make during a windshield survey of a community?
- housing and zoning
- health and morbidity
- open space or boundaries
- service centers or stores
- people on the street
- signs of decay
- common areas in a community
What is the purpose of completing a windshield survey?
- provides an overview of a particular community
- record objective and observable data
- information collected helps a nurse define a particular community by observing trends and areas that may need change regarding individual's health in the community
- needs to know this information before planning interventions in order to know what issues are affecting individual's health and what is or is not avaiable to members of a community
In assessing the community core, what data is collected?
- about the people and the community
- people's history, beliefs, values, characteristics
What is important when assessing the history of a community and where could this informatio be assessed?
- find out about the origin of the community
- how did the community develop?
- prominent leaders and residents?
- major events that shaped the community?
- libraries, historical societies, chamber of commerce
What does demographic data describe?
- the people of the community using numbers and statistics
- population by age, sex, race, and family types
- marital status, birth and death rates
- population growth and trends
Why is it important to assess a community's values, beliefs and religion?
help us understand what is important to the residents of a community
What is involved in assessing a community's physical environment?
- first, conduct a windshield survey
- also includes data on the community's vital signs and terrain
What is involved in assessing health and social services of a community?
- both intra/extracommunity resources
- data is collected on: hospitals, clinics, public health clinics, nursing home, home health agencies, rehab facilities, mental health clinics, and health care practitioners, EMS services
What is involved in assessing economics of a community?
- data is collected on median household income of residents, % of families with income below poverty level, selected industries within the community, the labor force of the community, occupations of the community's residents,community's unemployment rate
- its important to compare the community's unemployment rate to the parish, state and nation
What is involved in assessing safety and transportation of a community?
data collection on protective services (police, fire), sanitation, clean water supply, air quality, and transportation infrastructure of the community
What is involved in assessing politics and government of a community?
structure and function of the commuity's government
What is involved in assessing communitcation of a community?
- both formal and informal communitcation
- formal-t.v., radio, newspaper, postal service, telephone services and internet service providers
- informal-almost always originates within a community (intracommunity), bulletin boards, posters, hand-delivered fliers, school and church newsletters
What is involved in assessing education of a community?
years of schools completed by residents, high school drop out rate, current school enrollment, ability of residents to speak english
What is involved in assessing recreation in a community?
look at both intra/extracommunity resources within 50 miles of the community
the study of population health
- -the word is derived from the Greek words "epi" (meaning upon), "demos" (meaning people), and "logos" (meaning the science or study of)
- "what is upon the people" in terms of illness and disease
Who defined epidemiolgoy as the study of the distribution of states of health and of the determinants of deviations from health in populations?
What do epidemiology studies focus on?
- 1. the occurrence of disease (descriptive epidemiology)
- 2. the cause of disease (analytic epidemiology)
seeks to explain person, place, and time; who has the disease, where are they (geographically) and when did they get it?
seeks to determine the cause or determinants of the disease; how did the disease develop or spread and why?
The process of surveillance collects what data?
- both occurrence and causality data
- this process requires HCP to report cases of infectious disease to the apporpriate agencies
HCP, including nurses, are required to report known cases of certain infectious diseases
in epidemiology, refers to the frequency of a disease or illness in a defined population over a specific period of time
the number of persons in a specific population who develop a disease over time
- measured over a span of time
the number of persons in a specific population who have a disease at a certain time
- measured as a one-shot or slice of time
- looks at occurrence of disease on a given point in time
What does the numerator and denominator represent in the fraction for calculating rates?
- The formula for calculating rates can be thought of as a fraction, in which the numerator is the total number of
- people experiencing the health problem or disease, and the denominator is the total number of
- persons who have the possibility (risk) of experiencing the health problem or disease.
the prescence of a disease or illness
- both incidence and prevalence are measures of morbidity
death; an estimation of the proportion of a population that dies during a specific time period
the number of new cases or deaths for an entire population
- crude rate
- The population as a whole is used as the denominator (or group at risk) in calculating a crude rate
the frequency if a characteristic in a particular population
- specific rate
- A specific subgroup of the population is used as the denominator in calculating a specific rate
not a true rate at all, It is an imaginary rate that is statistically calculated to “adjust” for some factor
- adjusted rate
- Factors that are commonly adjusted for include age, sex, and race, however, statistical adjustments may be made for many other factors as well
- Adjusted rates are useful when comparing two different groups (populations) of people, and answering “What if” type questions
- not real rates so should be interpreted with caution!
The usual frequency of a disease within a population is referred to as?
The appearance of several cases
of a disease (usually in a short period of time) in a population experiencing no cases or only sporadic cases of the disease is referred to as an
a high rate of the disease in a population
refers to an epidemic involving more than one continent, or a world wide epidemic (such as HIV/AIDS)
Epidemiologist use what model to identify and study the cause of disease?
What are the 3 components of the epidemiology triangle?
- the agent
- the host
- the environment
a factor whose presence, excessive presence, or relative absence is essential for the occurrence of a disease
- the agent
- Agents may be physical, chemical, biologic, genetic, or psychological
- Agents are characterized by "infectivity" and "pathogenicity"
The property of being able to lodge and multiply in a host, thus the ability to infect a host
The ability of an organism to produce overt disease
the person, animal, or organism that provides subsistence or lodgment to an
- the host
- The host is classified as "susceptible to," "immune to," or "infected by," the agent
refers to the likelihood (probability) that an agent will infect a host
- host risk
- there are severla analytical measures that assess risk
divides the incidence rate among those exposed to some factor by the incidence rate among those not
an attribute or exposure that
increases the probability of occurrence of disease
- risk factor
- Risk factors may include lifestyle, health
- practices, genetics, race, age, sex, etc
includes all external conditions and influences affecting the life of living things
- the environment
- External conditions may include the temperature, geography, noise, pollutants, housing, economics, social surroundings, etc
What are the 3 stages of transmission of infectious disease?
- 1. Escape from the old host
- 2. Travel to the new host
- 3. Entry into the new host
occurs via close contact (shaking hands, etc.), or by intimate contact (sexual, exchange of body fluids)
occurs via "vectors" (a living agent which transmits infectious diseases
such as mosquitoes, fleas, ticks, etc.), "vehicles" (a non-living object that transmits infectious diseases such as pencils, doorknobs, handkerchiefs, etc), and "fomites" (food or water)
simple statistical measures that describe the population; literally means “writing about the people.”
- derived from Greek words "demos" (meaning people), and "graphos" (meaning to write)
- Demographic data may include such things as the size of a population, as well as the age, gender, race, etc. of a population, SES
include data on births, deaths, marriages and divorces
What does demographic information provide?
provide information about the characteristics of a population, and are useful in determining potential health care needs based on these characteristics
The windshield survey is considered what type of data?
What type of data is the interview considered?
Numerical or statistical data is considered what type of data?
What are the 4 steps involved in analyzing commuity assessment data?
- 1. categorize the data collected during the assessment phase
- 2. summarize the data collected
- 3. compare the data to parish, state, and nation-look for patterns or themes within the data as well as omissions and incongruiencies
- 4. make inferences and draw conclusions based on the data collected which will help you create a problems list
- -rank the problems in terms of importance or priority
What is the next step after creating a problems list?
developing a community diagnosis
A community health diagnosis is a narrative statement that does what?
- 1. describe an actual or potential risk (problem)
- 2. describe the population (group) at risk
- 3. implies at etiology (the cause or contributing factors)
- 4. gives evidence to support the problem or risk (such as statistical data)
What should the community health diagnosis include?
risk of ____ among ____ related to ____ as evidenced by ____.
help establish on the front end what the desired outcome is on the back end
What is important to remember when writing community goals?
that it is the community's goal, not the nurses goal
What are the 4 criteria that a goal should meet?
- 1. goal must be realistic/achievable
- 2. goal must be measurable
- 3. goal was be time oriented
- 4. goals must be client ("community") focused
the thing that the nurse will do to help the client (community) achieve its goal
What are the 3 factors that must be considered when planning community interventions? Which is the most critical?
- 1. interventions should incorporate the cultural norms of the community
- 2. interventions must be accessible to the members of the community
- 3. interventions must be affordable
- #3 is the most critical
Interventions include considering what...?
considering who, what, where, when, and how
interventions that focud on prevention of a stressor before it occurs
- primary interventions
- Educational programs that help prevent a certain behavior or lifestyle is one example of a primary intervention
interventions that focus on screenings or focus on identifying persons at risk for a stressor and/or persons that have already been exposed to a stressor and are still in the early stages of exposure
- secondary interventions
- i.e. conducting a written survey or blood pressure screening
interventions that focus on treatment, coping, and/or adaptation and on minimizing negative outcomes in persons alreay exposed to a stressor
- tertiary interventions
- i.e. organizing a support group for persons already affected by a health issue is one example of a tertiary intervention
change that happens everyday in our lives
- unplanned change
- For example, you may be driving to campus for an 8:00 a.m. class and suddenly encounter a traffic jam on the interstate.
- You have no control over the situation, but you are forced to alter (change)your original plan of getting to class on time
well-thought out and goal-directed change
- planned change
- i.e. if you want to lose 10 lbs and join weight watchers, this is a plan to lose the weight
Identify and describe the 3 stages of Lewin's change theory.
- proposed a theory of planned change:
- 1. unfreezing-becomming aware of a problem and the need for change
- 2. moving-taking action or implementing activities to bring out change
- 3. refreezing-incorporating or maintaining the change
expanded upon Lewin's model and discussed the roles that nurses play as "change agents" in helping clients make a change
How many stages did Reinkemyer describe in his stages of planned change model?
- stage 1: I.D. and development of a felt need and desire for change
- 2: development of a change relationship between the community health nurse and the community
- 3: clarification or diagnosis of the community's problem, need, or objective
- 4: examination of alternative routes and tentative goals and intentions of actions (planning)
- 5: transformation of intentions into actual change (intervention)
- 6: stabilization and evaluation
- 7: termination of the relationship b/t the community health nurse and the community
a set of unified goals developed by multiple agents from across the U.S.
healthy people 2020
Describe how and when the "healthy people" intiative began?
- launched by the Department of Health and Human Services in 1979
- focused the needs of improvement on people's health
- emphasis was placed on the importance of setting goals that were based on the health needs of individuals
What are the overarching goals of healthy people 2020?
- eliminate preventable disease, disability, injury, and premature death
- achieve health equality, eliminate disparities, and improve the health of all groups
- create social and physical environments that promote good health for all
- promote healthy development and behaviors across every stage of life