Community-Oriented Nursing
Focus: Health of the community as a whole.
Client: Community
Activity: Surveillance and evaluation of the community's collective health, and the implementation of strategies to promote health and prevent disease.
Community-Based Nursing
Focus: Health of individuals, families, and groups within a community.
Client: Individuals, family, or group of individuals
Activity: Provision of direct primary care in the settings where individuals and families live, work, and "attend" (schools, camps,
Community Health Nursing
Systematic processes to deliver care to individuals, families, or community groups with a focus on promoting, preserving, protecting, and maintaining health care provided contributes to the health of the community.
Public Health Nursing
Nursing and public health, disease and disability prevention, promoting and protecting the health of the entire community
Eight domains of public health
Distinguishes public health nursing from other nursing specialties by adherence to the eight principles:
Analytical assessment skills
Policy development and program planning skills
Communication skills
Cultural competency skills
Community dimensions of pr
Three primary functions of public health
1. Assess health care function
2. Develop policy that provides access to services
3. Ensure services are delivered and outcomes achieved
Health People 2020: Four main goals
1. Eliminate preventable diseases, disability, injury, and premature death
2. Achieve health equity, eliminate disparities, and improve health of all age groups
3. Create social and physical environments that promote good health for all
4. Promote healthy
Social determinants
Impact whether someone is able to attain/maintain health;
(Income, social status, education, literacy, environment, support networks, gender, culture, available health care)
Disparities
Gaps in care experienced by one population compared to another
Health care changes in the 21st century
Increased patient acuity and number of services in the community.
Patient centered care
Increased patient responsibility for own health
Increased use of technology
Florence Nightingale
Studied nursing in Germany then established nursing schools in England
District Nursing
A mode of service delivery in which a community health nurse is responsible for addressing all the health needs of a given population
Lemuel Shattuck
First use of demographic data to look at population health birth and death records
Dorthea Dix
Established first hospital for the mentally ill in the US
Clara Barton
Civil war nurse: Established the American Red Cross (providing aid for natural disasters)
Lillian Wald
Found of public health nursing in the US; Founded the Henry Street Settlement and Visiting Nurse Service which provided nursing and social services and organized educational and cultural activities. She is considered the founder of public health nursing
Mary Breckenridge
Pioneer in nurse-midwifery; established the Frontier Nursing Service - nurses traveled on horseback to reach mothers in the hills of Kentucky
World Health Organization
International center that collects data, advances initiatives, and offers support related to public health
US Department of Health and Human Services (USDHHS)
US branch of government responsible for health and welfare of citizens
Nongovernment Agencies
Agencies that acquire resources from private sources to assist others
Philanthropic Agencies
Organization that uses endowments or private funding to address the needs of individuals, families, and populations
Center for Disease Control
(CDC) is a United States federal agency under the Department of Health and Human Services. It works to protect public health and safety by providing information to enhance health decisions, and it promotes health through partnerships with state health dep
Difference in US health care system and public health
The US has an individual focus on curative measures while public health focuses on the population or community as a whole and focuses on disease reduction and improved health
Local Level of Government
Implement public health activities within the community; Governed by the state department;
Structure varies based on community needs
State Level of Government
Focuses on regulation of the community of program responsibility and resource allocation
Federal Level of Government
Focuses on policy development and financing
Health
A quality, an ability to adapt to change or a resource to help cope with challenges and processes of daily living
Well Being
A subjective perception of full functional ability as a human being
USDHAHS 10 Components of public health practice
1. Preventing Epidemics
2. Protecting the environment, workplaces, and sources of food and water
3. Promoting health behavior
4. Monitoring the health status of the population
5. Mobilizing community resources into service
6. Responding to disasters
7. As
Epidemiological Health Promotion Model
The study of relationships among an agent, a host, and an environment. The interaction determines the development, and cessation of communicable disease.
Learning Theory
Goal established and reinforced by nurse; Rewards given for partial accomplishment
Health Belief Model
Cues used to remind people of health behavior and promote action; Perceived risk influences action
Transtheoretical Health Promotion Model
5-Step approach: Pre-contemplation, Contemplation, Preparation, Action, Maintenance
Reasoned Action Health Promotion Model
Performance of a behavior is determined by a persons intention to perform the behavior; Intentioned determined by attitude and behavior
Social Support Health Promotion Model
Change influenced by support of friends, families, and communities
Primary Level of Prevention
Utilize prevention strategies, address modifiable risk factors, and maximize health and wellness
Secondary Level of Prevention
Planned effort to minimize the impact of disease and injury once it has occurred
Tertiary Level of Prevention
Maximizing health and wellness through strategies set in place at the end-stage of disease and injury
Epidemiology
The study of the distribution and determinants of health and illness
Rate
Primary measurement used to describe either the occurrance or the existence of a specific state of health or illness
Outbreaks
Epidemic usually limited to a localized increase in the incidence of the illness
John Graunt
Father of demographics. recognized importance of recording birth and death rates and age structure of human population
William Farr
Set up a system of data collection for causes of death in difference occupations, gender, and imprisonment. Importance of definition of illness and population comparison, groups, and factors such as age, health, and environment can affect statistics
John Snow
Used mapping and rates as an objective measure to compare populations
Epidemiological Triad
Model based on the belief that health status is determined by the interaction of the characteristics of the host, agent, and environment
Wheel of Causation
Epidemiologic model that deemphasizes the agent as the sole cause of disease while emphasizing the interplay of physical, biological, and social environments
Web of Causation
Epidemioligcal model that strongly emphasizes the concept of multiple causation while deemphasizing the role of agents in explaining illness
Natural History of Disease
Course of disease or condition from the onset to resolution
Rate
Primary measure used to describe either the occurrence or existence of a specific state of health or illness within a group during a specific time frame
Ratio
Fraction that represents the relationship between two numbers; Divide one quantity by another quantity
Ex: # boys in class/# girls in class
Proportion
Type of ration
Ex: # boys/ total students
Crude Rate
Measures the occurrence of the condition in the whole population; May obscure info because it does not consider factors such as age, race, gender
Numerator: Number of events
Denominator: Total population (not just those at risk)
Adjusted Rate
Controls for differences between populations-used for comparison
Incidence
Measures probability that people without a condition will develop the condition over time; measures pace of new illness
Prevalence
Existence of a condition during a period/interval at a specific point; Studies number of people diagnosed in the past and length of illness; Longer length=greater the prevalence-indicates burned of community
Mortality Rates
Crude mortality: probability of dying from any cause; # deaths in a year/total population
Proportional Mortality Ratio
Compares death from a specific illness with deaths from all causes; # deaths from specific cause within a time frame/total deaths
Incidence Density
Used when unequal periods of observation for study subjects; Accounts for people who die, drop out of a study, or acquire an illness
Attributable Risk
The risk of a condition occurring in an exposed group that is attributable to an exposure, not other factors
Relative Risk Ratio
Measure of the risk of developing a condition; Ratio of incidence in exposed and incidence in non-exposed
Sensitivity
Ability of the test to correctly identify people who have the health problem
Specificity
Specific incidence and prevalence rates calculated based on specific characteristics (demographic data), variations based on location and variations in time (short-outbreak, periodic- seasonal, long-years)
Crude Rate Formula
# events within time period/population at risk with same time pt
Incidence Rate
#new cases during time period/population at risk in the same time period
Causality
Strengths of Association
Consistency
Temporality
Plausibility
Biological Gradient
Case Studies
In-depth analysis of individual or group, often first clue to a problem
Cohort Studies
(Longitudinal Studies) Monitor over time to find associations between risk factors and health;
Minimize selection bias;
Relative risk is the ratio of disease incidence in an exposed population;
Indicates strength of exposure to illness causality
Case Control
Compare group with health problems (cases) to group without (control)
Key Informants
Persons knowledgeable about specific aspects of a problem and the communities current and past attempts to address it
Stakeholders
An individual, organizational, or group that has interest (stake) in a specific community health issue or the outcome of a community level intervention
Gantt Chart
Visual of the sequence of steps to achieve objectives; Developed in planning stages to identify steps, a tool for scheduling tasks, monitor progress
Community of Interest
People and groups/aggregate that will be affected by change; Those that will help bring about change
Upstream Approach to Health Care
Changes at societal level may impact health of community without change is individual behavior
Sustainability
How to maintain change, support system in place
Social Justice
Health care is a risk; Address root cause of illness
Health Equities
Requires elimination of health disparities in living and working conditions
SMART objectives
S- Specific
M- Measurable
A- Achievable
R- Relevant
T- Time
Coalition Building
Community members participate in planning and implementing changes at the community level; Need clear mission, goals, objectives, expectations, leadership, accountability, and should be heterogenous
Community Readiness
Assess readiness to undertake change process-issue specific
Web of Causation
Identify multiple factors that contribute to chronic disease
Lewins Model for Change
Unfreezing:
Changing:
Freezing:
Levers of Change
Increase driving/reinforcing forces
Decrease restraining/resisting forces
Force Field Analysis
Identify factors within a community that impact change and forces that cannot be changes
Geopolitical Population
Has identified designated boundaries with the same governing structure
Phenomenological Population
Group with common interests or beliefs who have interpersonal and intrapersonal connection
Community of Solution
Formed by aggregate to address a health problem