Bumpy Design: Book Design and Composition

KIM SCOTT / kim@bumpy.comBOOK DESIGN + COMPOSITION
UNLIMITED Mastering Techniques
and Maximizing Creativity
with Your FUJIFILM Camera
DAN BAILEY
With FUJIFILM X Series Unlimited by your side, you’ll be
able to maximize your camera’s performance and gain
total creative liberation with your photography as you achieve
mastery with your FUJIFILM camera . . . no matter what X Series
camera you use. Written by professional photographer, expert
Fuji user, and X Series ambassador Dan Bailey, this book teaches
you every feature and every menu item, button, and function of
the FUJIFILM X Series lineup. More importantly, you’ll learn how
to use these features and settings in actual shooting situations out
in the world in order to capture great photographs.
Dan has shot with X Series cameras for nearly six years, and
he’s worked closely with the FUJIFILM tech reps and product
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teaches you everything he’s learned along the way.
You’ll learn all the camera settings, how to use autofocus,
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own “look,” how to set up the camera for maximum image
quality and performance, and many other features such as
bracketing, exposure modes, the ADV mode filters, how to update
firmware, and how to optimize your Fuji to match your style and
subject matter. The book is absolutely packed with tons of great
recommendations, advice, and insight. If you take the time
to learn and master just a few of the features covered in this
guide, you’ll be able to take your creative and technical skills
to a whole new level.
978-1-68198-387-5 US $29.95
DAN BAILEY has been a full-time
adventure, outdoor, and travel
photographer since 1996. His
immersive, first-person style of
shooting often places him right
alongside his subjects as he
documents the unfolding scene
and searches for the perfect
convergence of light, background,
and moment. A longtime user of
Fuji Photo Film and unwavering
devotee of VELVIA, Dan first
became enamored with the X Series
in the fall of 2011. He currently
shoots with the X-T2. Visit his
website at danbaileyphoto.com.
BAILEYXSERIESUNLIMITED
UNLIMITED Mastering Techniques and Maximizing
Creativity with Your FUJIFILM Camera
9781681983875_FujiX-Unlimited_cover_PRINT.indd 1 2/12/18 2:03 PM
A BLUEPRINT
for a KICK-ASS
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Retirement
My
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GARY A. WEUVE5
MyRetirementJournalABLUEPRINTforaKICK-ASS2ndACTLIFEWEUVE

Janet Beik
HealthInsuranceToday
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Elaine A. Gillingham
Monica Wadsworth Seibel
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Linda D. Urden
Kathleen M. Stacy
Mary E. Lough
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ADoBEMAStErCLASSPhotoShoPCoMPoSItIngwithJohnLund
Lund
Pfiffner
PhotoShoP®
CoMPoSItIng
with John Lund
A D o B E®
M A S t E r C L A S S
Simple techniques for making
magic in Adobe Photoshop
JoHn LUnD and PAMELA PfIffnEr
A Guide to Classifying Pain
a World
of HURT
Melissa C. Kolski • Annie O’Connor
a World of HURT
A Guide to Classifying Pain
This book presents an interpretation of the
nature of musculoskeletal pain. It describes a
classification system for assessment and treat-
ment of musculoskeletal pain with emphasis
on patient education and active exercise. This
approach to musculoskeletal pain has grown
out of theoretical considerations supported by
different levels of research and based on clinical
observations for the last 16 years at the Rehabil-
itation Institute of Chicago. Rather than offering
another technique, this approach provides you
with principles carried forward and supported by
research in how to educate and guide exercise for
your patients who suffer from musculoskeletal
pain. This book is unique in that it is intended
to serve both the clinicians who treat and the
patients who suffer from musculoskeletal pain
through education about pain mechanisms and
the active care associated with them.
Melissa C. Kolski, PT, OCS, Dip MDT, is an
education program manager and practicing clinician
at the Rehabilitation Institute of Chicago, with a
specialty interest in spine care and treatment of
patients with musculoskeletal pain and dysfunction.
Annie O’Connor, PT, OCS, Cert. MDT, is Corporate
Director of the Musculoskeletal Practice and Clinical
Manager of the River Forest Spine and Sport Center
at the Rehabilitation Institute of Chicago.
These highly regarded clinicians have combined
two different but overlapping research-backed
classification systems into a common sense,
effective way to manage musculoskeletal pain.
This book serves as an essential guidebook for
old and new clinicians seeking active pain man-
agement strategies for their patients, especially
for chronic pain.
—Jane Borgehammar, PT, Dip MDT
Owner, Synergy PT LLC
A World of Hurt brilliantly selects the best ele-
ments from two medical classification systems
to create one useful and comprehensive guide to
classifying pain. A groundbreaking effort that will
undoubtedly lead to better outcomes for patients
with pain and an improved utilization of the health
care system. A World of Hurt outlines an integra-
tive approach to pain classification and contains
practical guidance on how to approach many
problems and ailments not easily accessible to
conventional diagnosis or treatment. A guide like
this is long overdue.
—Thomas J. Lotus, DC, FACO, Cert. MDT
Spine & Sports Center of Chicago:
Owner & Clinical Manager
A book that incorporates both the highly effec-
tive pain mechanism classification system and
the well-known McKenzie Method of Mechani-
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share this exciting approach with all of us in their
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book close to you during your clinic time and refer
to it with each patient to help determine which
type of pain they have.
—Michael C. Geraci, Jr., MD PT
Board Certified, Physical Medicine &
Rehabilitation and Sports Medicine
Medical Director & Owner,
Michael C. Geraci, Jr., MD, P.C
Clinical Associate Professor, SUNY @ Buffalo School
of Medicine and Biomedical Sciences
Michigan State University,
College of Osteopathic Medicine
aWorldofHURTAGuidetoClassifyingPainKolski•O’Connor

FINANCIAL
MANAGEMENT
for Nurse Managers and Executives
Steven A. Finkler
Cheryl B. Jones
Christine T. Kovner
FOURTH EDITION
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Finkler4e_cover_final.indd 1 12/7/11 10:16 PM
Evolving Technologies
& Clinical Practice
MARY E. LOUGH
HEMODYNAMIC
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creating &
sustaining
civility
in nursing education
Cynthia Clark
creating&sustainingcivilityinnursingeducation
Clark
www.nursingknowledge.org/sttibooks
USD $34.95
Creating & Sustaining Civility in Nursing
Education provides a comprehensive overview of
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Join the author for an informed discussion on the
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Clark focuses on solutions, including positive role-
modeling and mentoring, stress management, positive
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Cynthia Clark, PhD, RN, ANEF, FAAN, is a professor in
the School of Nursing at Boise State University and an
internationally known lecturer and author specializing in
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of Nursing and the National League for Nursing Academy of
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“Clark’s compelling work has
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—Susan Luparell, PhD,
ACNS‑BC, CNE
Associate Professor
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College of Nursing
“This book provides practical
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“Clark’s book is a treasure
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—Marion E. Broome,
PhD, RN, FAAN
Dean & Distinguished
Professor, Indiana
University School of Nursing
Editor, Nursing Outlook
a faculty field guide
foreword by Diane M. Billings
A Nurse’s Guide to
End-of-Life Care
Linda Norlander
To
Always
Comfort
SecoNd editioN
ANurse’sGuideto
end-of-LifecaretocomfortAlways
Linda Norlander, MS, BSN, RN, is Director of Clinical Services for
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“This book is a ‘nuts and bolts’
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PhD, RN, MA, FAAN, FPCN, CHPN
Director and Professor
Department of Nursing Research
and Education
City of Hope National Medical Center
“Norlander provides a gentle,
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–Joan “Jody” Chrastek,
DNP, RN, CHPN
Pediatric Advanced Complex
Care Coordinator
University of Minnesota/
Fairview Home Care and Hospice
US $34.95To Comfort Always is an award-winning
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Always provides a practical framework that
differentiates end-of-life nursing in terms
of skilled clinician, advocate, and guide.
Content includes:
• Educating your patients, their families,
and yourself about illnesses
• Guiding patients and families through
the stages of dementia
• Conducting pain assessments
• Advocating for the needs of patients
and families
• Assessing and engaging when death
is near
• Understanding the specific needs of
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Norlander
Second
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www.nursingknowledge.org/sttibooks
TCA2e_CVR_FINAL_05-09-14.indd 1 5/9/14 9:47 AM

BOOK INTERIOR
DESIGN + COMPOSITION

CHROMA: A Photographer’s Guide to Lighting with Color, by Nick Fancher
Rocky Nook / interior design, template setup, custom composition
CHAPTER 6
SHUTTER DRAG
The addition of movement or blurring can add a wonderful sense
of drama to an image. When using a slow shutter speed—typically
1/30 or slower—(often) in combination with a flash, you can create
an image with blurred light and a frozen subject. This technique is
referred to as shutter drag. Many times you will see the technique
used in long exposures at night, or in event photography, capturing
kinetic subjects like athletes or dancing couples at a wedding. It can
be used in many more ways, which we will cover in this chapter.
“Color directly influences the soul. Color is the keyboard,
the eyes are the hammers, the soul is the piano with many strings.
The artist is the hand that plays, touching one key
or another purposively, to cause vibrations in the soul.”
–Wassily Kandinsky
Another important thing to consider is how to retain drama in your image. I went
to great lengths to make an eye-catching image, from my model selection to who
I selected to do hair and makeup to how I lit and posed my model. All that is for
naught if I’m unable to carry the image the rest of the way to the finish line by
properly handling it in post-processing. Look at how dramatically different the
same image looks in Figure 7.25, with just a few tweaks in the Basic panel and
tone curve. The top image was my initial color grading. After walking away from my
computer screen for a few hours and returning to the image, I could see that I was
overexposing it in Lightroom, losing the drama that I had constructing with my light-
ing. By lowering the Exposure slider, cooling off the temperature, bumping up the
highlights (to offset the lowered exposure), and raising the shadow portion of the
red tone curve, I got Figure 7.26. Emilija is blue, with red highlights around her face
and in her eyes.
Figure 7.25 The Lightroom settings. By lowering the exposure, cooling off the temperature, raising the
highlights, and raising the shadows areas of the red tone curve, I was able to get a dramatic color grade.
152 A D D I N G CO LO R TO S H A DOWS
Figure 7.26 The final shot. Emilija is blue, with red highlights around her face and in her eyes.
U N D E R L AY E R 153
We worked through our shot list the next morning, making sure to leave an hour
at the end to play with color. We started by hanging a vibrant purple curtain
(Figure 3.12). I added white boxes to my scene in order to see how my colored
lights would interact with both the subject (once they were dressed) and the back-
ground, Figure 3.13.
I ended up going settling on cyan and yellow gels for my lights. I placed the yellow
light to the left and cyan to the right, both at relatively extreme angles to the fabric.
The extreme angle of the lights to the curtain accentuated the folds of the fabric
rather than flattening them out, as they would if the lights were shining directly at
the curtains.
In Figure 3.14, you can see the cyan layer of light; you can see the yellow layer of
light in Figure 3.15. The yellow interacted with the purple to make a gold/brown
color, while the cyan pushed the purple fabric to a royal blue. Since the yellow light
was at slightly more of a side angle to the backdrop, it didn’t light the deep folds of
the fabric, only the surface. The cyan light, which was slightly more frontal, not only
filled in the fabric’s shadows, but helped neutralize the overall yellow/brown color
on the curtain’s surface, save for where the subject blocked the cyan light, creating
the yellow background shadow seen in Figure 3.16.
Figure 3.12 We picked this vibrant purple
fabric to use as a backdrop.
Figure 3.13 I added white boxes to the shot to
see how my gelled lights would interact with
both the subject and the colored background.
60 LI G HTI N G I N L AY E RS
Figure 3.14 This is the cyan layer of light. It
is slightly frontal, and doesn’t create many
shadows.
Figure 3.15 This is the yellow layer of light. It is
a bit more side-angled, and highlights more of
the fabric’s folds.
Figure 3.16 This is the RAW file with both cyan and yellow layers of light.
B LE N D I N G CO LO R E D LI G HT O N CO LO R E D SU R FAC E S 61
EXPLORING COLOR RELATIONSHIPS
A continuous light source is a fantastic learning tool for understanding color rela-
tionships. For this image, I rented a 3-light LED kit made by Fiilex from my friends at
Midwest Photo Exchange, and picked up some gels big enough to accommodate
them. The LEDs are small, don’t get too hot, allow you to shift color temperature,
and have dimmer switches. Having a dimmer is invaluable since gel densities differ
greatly from one gel to the next. When I need to balance a red-, a green-, and a
blue-gelled light, for example, the red and green lights need to be dimmed to about
half power to balance with the blue-gelled light.
I gelled the three lights and set them up side by side to light a plant vase
(Figure 5.1). Once I dialed in a proper ratio between the three lights, a hot spot of
colorless light was formed in the center, per the additive color model. Outside the
hot spot, the individual colors become more distinct. The benefit of using a continu-
ous light source to get these colors, as opposed to a flash, is that I can easily study
color relationships as I change the angle and positions of each colored light. I can
see how different color combinations interact when I power each light up and down
one light at a time. You can see in Figure 5.2 what the different color combinations
looked like from these three gelled lamps.
Figure 5.1 The setup.
The three lights are gelled
red, green, and blue and
placed side by side.
102 CO NTI N UOUS LI G HT
After exploring the different color options, I decided that I wanted slightly longer
shadows, so I moved the lights back a foot. Lowering the stands would’ve also
worked. A lower light source will cast longer shadows (think how the setting sun
casts long shadows). After taking a shot using all three lights (Figure 5.3), I wanted
to eliminate the predominant black shadow. I could see that by moving one of the
lights around to the other side of the vase (Figure 5.4), I could fill in the shadow
with color, while retaining an area of colorless light to illuminate the white vase
(Figure 5.5).
Figure 5.2 The image on the left was lit with red and green light; the image in the middle was lit with blue and green
light; the image on the right was lit with blue and red light.
Figure 5.5 The vase is still lit with colorless
light, and the colorless shadow is gone.
Figure 5.4 In order to eliminate the colorless shadow, I moved one
of the lights to the other side of the vase.
Figure 5.3 Colorless light formed
where the three lights overlapped, and
illuminated the white vase. Colorful
shadows are visible behind the vase.
E X PLO R I N G CO LO R R E L ATI O N S H I PS 103

Within the Frame, 10th Anniversary Edition, by David duChemin
▶ 20mm, 1/125 @ f/4.5, ISO 800
Northern Kenya. These wells go deeper than I imagined. What you cannot see are six or more other
warriors down that hole, passing up the water, and singing as they do it. The motion of this was
important to me; a faster shutter speed would have lost the magic.
CHAPTER 2
Within the Frame
t h e r e i s o n l y t h e f r a m e . That is our craft. Painting with light, in slivers
of time, within the frame of our image. It becomes art when that combination says
something in a unique way. And to think, when I learned about photography, it
seemed like it was merely a matter of pointing the camera at something and pressing
the button. If you’re reading this book and you’ve mastered pointing and pressing
and you’re longing to see if you can’t just express something a little more than “I was
here,” then it begins with the frame. And one by one you put the elements in, move
them around until they please your eye—and your heart—and something inside says,
“Aha!” And you want to make other people say “Aha!” as well. That’s photography:
the discipline of cramming your vision into a frame and making it fit.
1 8 Within the Frame
Your choice in framing the image—oriented vertically or horizontally—
contributes as much to your storytelling as what you put within the
frame. A vertically framed image draws the eye up and down, to tall lines,
buildings, and people standing. A horizontal frame draws attention to the
left-to-right dynamic and is generally stronger as a storytelling format.
Whatever way you choose to orient your frame, it’s important. It gives your
viewers a visual clue—you corral their eyes and attention into a certain
direction in the same way a magician says, “Look here,” while doing the
dirty work with the other hand. It’s attention management, and by choos-
ing to place your story within one frame instead of another you are saying,
“Look here. Look in this way.”
It can, of course, be chalked up to aesthetics and personal taste. Some
framing just “looks better,” and some photographers make their deci-
sions based on an intuitive “it just felt right” kind of feeling. That doesn’t
diminish the need to carefully consider the orientation of the frame. If it’s
intuitive for you, great. But in the end, it’s all about what tools make your
photographs “just look better.” The important question is, “What does
‘better’ mean?” I suspect it means that your image communicates your
vision more compellingly. A second question, equally important, is, “How
do I get there?”
Excluding It from the Frame
As important as it is to get every element within the frame, it’s equally
important to exclude the rest. You know how they say “less is more”? Well,
sometimes less is just less, as when the story you are trying to tell within
the frame is missing a key character or element. But when you’ve got it all
there and the visual story is complete—and your vision realized—anything
extra has a subtractive effect on the impact of your image, and more is less.
The story is told of Michelangelo being asked about his methods for
sculpting. He replied simply that he worked on a block of marble, removing
all that was not part of the sculpture until only the sculpture remained.
To allow your
images to communi-
cate to the broadest
audience possible,
you need to be
obsessively aware
of what is within
the frame.
▲ 26mm, 1/160 @ f/2.8, ISO 800
Awash, Ethiopia. The colors and the contrast between the sparse stall
and the cheerful boy make this a strong complement to the detail shot of
his hands.
▲ 70mm, 1/400 @ f/2.8, ISO 800
Awash, Ethiopia. A roadside vendor selling decorated
gourds, of which one can never have too many.
1 9 2 Within the Frame
not shooting everything that Vietnam has to offer? Maybe. But there’s a
better chance you’d regret not taking your time, slowing down, truly meet-
ing the place, and then creating images that reflect that. You can’t do that
when you’re spending half your time going from place to place.
Wandering aimlessly is about what you choose to see, while slowing
down is about how much time you allow yourself to see it, to soak it in, to
listen to the place. The longer you take, the better you hear it. We don’t
always have that luxury, but when we do, our photographs reflect it.
It’s not easy to see the details when you’re rushing past them, and
it’s impossible to shoot them when you’re in a vehicle. The few times I’ve
succeeded, it’s been sheer dumb luck. To truly experience a place, you need
to walk it, smell it, taste it. You need to engage it on a level not possible at
a running pace or in a car with the windows up and the AC on. Get out.
Slow down. Hang out with the locals. Hear their stories, play with their
children, watch them as they worship, work, eat, play. Participate where
you can. This is true of any place, whether at home or abroad. You need to
walk with camera in hand, take your time, and be willing to get diverted,
distracted, and just plain lost.
The Feel of Place: Sensual Exploration
One of my favorite places in the world is Old Delhi, particularly Chandni
Chowk. Walking it is sensory chaos: it’s loud—the din of horns and bells
and voices is inescapable. The air is thick with smells of diesel fumes,
motor oil, incense, and goats (both alive and recently butchered). It’s a
place you experience with every sense, each new smell or sound turning
your head and pushing your curiosity. It’s overwhelming and exhausting.
But when walking it with camera in hand, it’s a place you can’t help but feel
strongly about. I come out of Chandni Chowk with more images on a single
outing than I gather in a week in other places. I think the more levels on
which a place engages and captivates you, the more compelled you are—
and the more able you are—to photograph it.
▶ 73mm, 1/250
@ f/4.5, ISO 200
Havana, Cuba. I have no
idea where I shot this.
Old Havana somewhere.
I didn’t even know I was
looking for this image
until it found me.
help you see past the words and grammar of the visual language and find a
story worth telling. One of the great gifts to photography in recent years is
the iPhone and the mobile photography movement in general. Some of my
favorite photographs have been made with these simple cameras, and they
prove that it’s the composition and vision that matter, not the complexity
or name brand of the gear.
For the natural artist, the road to serving your vision might be even
more difficult. The geek has only to fast from his addiction and learn to
feel a little more deeply. You—the poet, the artist—may need to learn the
nuts and bolts of your craft: take a course in lighting, learn about histo-
grams and adjustment layers. For an artist, this can be truly difficult. It
▲ 7.4mm, 0.8 seconds
@ f/2.8 with flash,
ISO 80
Bangkok, Thailand.
Chapter 3 The Artist and the Geek 4 7
might be time for a workshop or a month’s worth of video tutorials. The
goal is not to abandon or even neglect your artistic side; the goal is to pro-
vide you with the greatest possible grasp of the available tools so you’re as
capable of expressing your vision as possible.
Three images go into making your final photograph. The first is the
image you visualize—the story you are compelled to tell. The second is
the scene you capture with the camera. The third is the image you refine
in post-production. The better we are at all of these, the closer our final
photograph will come to reflecting our initial vision. The more harmoni-
ously the artist and the geek can coexist, and the better they both are at
what they do, the more powerful and powerfully communicated our vision
will be.
By all means, geek out on the gear, but don’t forget that without vision
the whole thing falls apart and devolves. It stops being photography and
just winds up as an addiction to expensive, soon-to-be-obsolete gear. Your
vision, and the photographs you take, will last much, much longer. No one
cares if you create your images with a Canon or a Nikon; they care if the
photograph moves them.
CREATIVE EXERCISE
Before diving into technical things, it’s important to remember that the heart of a great
image seldom has anything to do with the technical. It is assumed that you will get good
at your craft. No one should have to tell us we need to understand focus and exposure.
But we often need reminding that it is not those things that carry a photograph, tell a
great story, or hook us emotionally. Not once have I been deeply moved by a photograph
on account of its sharpness. In order to remind ourselves of this, it’s helpful to go out now
and then (often, even) with only the most basic of cameras. My preference? My iPhone.
Free from bells and whistles and the choices of a DSLR, time with my iPhone is often more
creative, more liberating, and—in the end—more productive. The simplicity prevents me
from relying on gimmicks and technical prowess and forces me to consider my choice of
moments, composition, and light much more carefully. n
No one cares if you
create your images
with a Canon or a
Nikon; they care
if the photograph
moves them.

The Photographer’s Guide to Posing, by Lindsay Adler
MASTERING Your Craft
ARMS ON THE CHAIR
Be aware of how you pose the arms on a chair. If you lean the arms
over the back of the chair, it can make the shoulders look slouched
(FIGURE 6.42). This same pose, however, can be used to beef up the
biceps by putting pressure on the muscles (FIGURE 6.43). n
6.42 The shoulders have better positioning and the subject
looks relaxed.
6.43 The shoulders are a bit more slouched, but the pose
is more aggressive and allows the subject to place pressure
on his biceps to make them look larger.
192 PoSING MEN
06_Posing_r3.indd 192 3/15/17 4:38 PM
Watch Out for the Crotch
If you direct a man to sit for a pose, you may need to tweak the pose so
that the eyes aren’t drawn between the legs. This may mean changing the
angle of the body, adjusting the camera angle, or placing the hands in such
a way that they obscure that area. Sometimes it may not be distracting;
other times it may draw too much attention. In FIGURE 6.44, I’ve invited the
subject to take a seat leaning forward. unfortunately, when he leans for-
ward his hand placement looks very awkward and distracting. Furthermore,
the camera angle and hand placement direct my eye between his legs. To
fix this problem, I tweak the pose by adjusting the position of the hands
(FIGURE 6.45). The change creates structure in the pose and more natural
hands, while also obscuring the crotch.
6.44 In the first shot, the hands look
awkward and need to be tweaked. Further-
more, the eye is drawn to the crotch (above).
6.45 Tweaking his initial pose produces
much more pleasing results (right).
193GuIDELINES FoR PoSING MEN
06_Posing_r3.indd 193 3/15/17 4:38 PM
5GO-TO POSES for Couples
POSE 1 she stands behind and to the side,
with her arms wrapped around his shoulders.
POSE 2 They face each other just before
kissing. Her right hand is on her hip, her left
hand to his chest. His hands are to her hips
and holding her raised arm.
246 PosIng CoUPLEs
07_Posing_r3.indd 246 3/15/17 4:39 PM
5GO-TO POSES for Couples
POSE 3 she places her
arms loosely over his
shoulders and neck while
she looks at the camera.
POSE 4 They face each other, his hand on her
hip while he kisses her head. Her hand is on his
shoulder.
POSE 5 He stands behind her with her back to
him, with his hand to her arm.
2475 go-To PosEs FoR CoUPLEs
07_Posing_r3.indd 247 3/15/17 4:39 PM
Directing
Directing is a very important part of posing and flattering our subjects. The
way we communicate action to our subjects is what will help them achieve
better body position or expression. Directing is our way to pull the best out
of our subjects, even those who are uncomfortable in front of the camera.
Many photographers prefer to think of the act of posing their subjects as
“directing.” To some photographers or subjects, the term “posing” has a
negative connotation of stiff, unrealistic, or uncomfortable looks in a shot.
People think of “directing” as more of an organic collaboration between
subject and photographer. Regardless of how you think of the terminology,
you need to be constantly telling your subject what to do and what you are
looking for. Lack of direction often makes people uncomfortable. When I
direct, I use a combination of my words, my body, and my gestures to com-
municate what I’m looking for.
Mirroring
Whether I’m posing the head or entire body, when I direct my subject, I
do the same pose for them to mirror. If I want them to stick their hip out,
I’ll stick my hip out. If I want them to turn their head to the left toward the
light, I turn my head toward the light. I try to create the pose from the feet
up to the head and hands. Obviously, I know that my subject may have a
completely different body type and the pose I’m creating with my body may
even look silly, but that’s not the point. Rather, I’m showing them how to
position their body in a way that is easy for them to interpret and re-create.
CAUTION Do Not Touch Your Subjects! I seldom touch my subjects, especially if
I am just trying to achieve a slight adjustment to the pose. Instead, I use words, mirroring, and
hand gestures. There is no reason for me to invade their personal space or make unnecessary
physical contact. Sure, there may be a time when I want to fix a collar or move their hair. When
I do so, however, I pause and ask permission first. Then I approach slowly and keep the contact
to a minimum. I do this out of respect for my subjects, and 99 percent of the time everything I
want to direct can be achieved without touching them.
36 POsIng AnD DIRECTIng THE FACE
02_Posing_r3.indd 36 3/15/17 2:34 PM
Gesture
Through mirroring and hand gestures, I can
tweak even the smallest details on my subject
without having to use any words at all. Hand
movements can be extremely powerful if used
with care.
When I want my subject’s face to be straight
toward the camera, I place my fingers together in
a vertical “karate chop” position with my hands
lined up with the center of their face. I often
begin posing with their face straight on, and then
make necessary adjustments beginning with this
position (FIGURE 2.1).
When I want my subject to turn their head, I use
my thumb and index finger close together to cre-
ate a shape as if I’m grabbing the subject’s chin.
From there, I move my hand to the left or to the
right to indicate which way I want them to turn
their head. Typically, I move my head as well for
an extra level of communication (FIGURE 2.2).
When I want my subject to tilt their head, I use
one hand to create a shape—like I’m picking up
a jar from a shelf—as if to grab the sides of their
face. I then rotate my hand from side to side to
indicate tilt and the amount of tilt desired. Typi-
cally, I also move my head to indicate the direc-
tion and how to tilt (FIGURE 2.3).
When I want to adjust the shoulders toward or
away from the camera, I position my hands as
if I’m grabbing their shoulders. Then I move my
hands toward or away from the camera, as if I’m
using an elliptical machine, to indicate the dis-
tance and direction of the shoulders.
2.1 I directed my subject so that her face was
photographed straight on, her chin aligned with
the camera.
2.2 For this photograph, I asked the subject to
turn her head to her right.
2.3 Here, I asked my subject to tilt her head to
her right.
37DIRECTIng
02_Posing_r3.indd 37 3/15/17 2:34 PM
01_Posing_r3.indd 12 3/15/17 4:36 PM
One of the biggest obstacles that photographers face with posing
is understanding how their camera sees. You may have a beautiful
pose that flatters your subject, but the lens, direction, and camera
angle you have chosen may prove to be unflattering. Similarly, a
pose may look somewhat unnatural to the naked eye, yet because
of your camera angle and lens choice, the shot comes out stunning!
Posing is not a stand-alone aspect of photography. It works in
conjunction with perspective and how your camera sees and
interprets your subject. In fact, these elements are inextricable.
For that reason, we need to take some time to truly understand
this intertwining of tools.
POSING and
HOW YOUR
CAMERA SEES
CHAPTER 1
13
01_Posing_r3.indd 13 3/15/17 4:36 PM

Population-Based Public Health Clinical Manual, 3e, by Patricia M. Schoon and Carolyn M. Porta
Sigma Nursing / interior design, template setup, custom composition
248 PART II n Entry-Level Population-Based Public Health Nursing Competencies
n PHNs can increase the potential for program or inter-
vention success by carefully examining the key cultural
or social beliefs or practices within a community.
n Reflecting on your own reactions toward those who are
different from you is a critical starting point toward
achieving this competency.
n Remember that policies can promote acceptance or
judgment of people or groups and that they should be
made with input from diverse stakeholders.
KEY POINTS
n Even the most experienced PHNs can struggle with
being nonjudgmental and accepting of other people.
n People and communities can be different from each
other on multiple levels, including social, economic,
geographic, religious, behavioral, age, ethnicity, race, or
sexual orientation.
n Acting in a nonjudgmental manner does not mean that
PHNs are accepting of everything.
REFLECTIVE PRACTICE
Considering what you have learned in this chapter, identify
what Josie might do next to act on her reflections during the
home visit and her realization that her preconceived judg-
ments are not only inaccurate but also not helpful in provid-
ing optimal care for the teen and her new baby.
1. What does Josie need to understand about being
nonjudgmental and accepting?
2. What are some additional reflective questions that Josie
needs to ask herself, and which information sources
might be useful to her in growing more accepting
of others?
3. How will Josie know that her efforts to be increasingly
accepting of diverse people and communities are
successful?
4. How might the Cornerstones (see Chapter 1) inform
Josie’s efforts to be accepting and nonjudgmental?
APPLICATION OF EVIDENCE
1. Which ethical considerations are important to think
about when responding to individuals, families, and
communities in a nonjudgmental manner?
2. How might you work with colleagues to process
judgmental feelings and work toward becoming more
nonjudgmental?
3. What might you do to contribute to a work culture that
supports nonjudgmental and unconditional acceptance
of people?
References
Aston, M., Meagher-Stewart, D., Sheppard-Lemoine, D., Vukic, A.,
& Chircop, A. (2006). Family health nursing and empowering
relationships. Pediatric Nursing, 32(1), 61–67.
Center for Spirituality and Healing. (2013). Deep listening.
Retrieved from https://www.csh.umn.edu/education/
focus-areas/whole-systems-healing/leadership/deep-listening
Cioffi, J. (2003). Communicating with culturally and linguistically
diverse patients in an acute care setting: Nurses’ experiences.
International Journal of Nursing Studies, 40(3), 299–306.
Debesay, J., Harsløf, I., Rechel, B., & Vike, H. (2014). Dispensing
emotions: Norwegian community nurses’ handling of diversity
in a changing organizational context. Social Science & Medicine,
119, 74–80.
Dillon, R. (1992). Respect and care: Toward a moral integration.
Canadian Journal of Philosophy, 22(1), 105–132.
Falk-Rafael, A., & Betker, C. (2012). The primacy of relationships:
A study of public health nursing practice from a critical caring
perspective. Advances in Nursing Science, 35(4), 315–332.
Gallardo, M. (2014). An invitation to dialogue and reflection. In
M. E. Gallardo (Ed.), Developing cultural humility (pp. 1–25).
Thousand Oaks, CA: SAGE Publications.
Garneau, A. B., Pepin, J., & Gendron, S. (2017). Nurse-environment
interactions in the development of cultural competence.
International Journal of Nursing Education Scholarship, 14(1).
doi:10.1515/ijnes-2016-0028
235
‘‘
’’
CHAPTER
12
COMPETENCY #10
Demonstrates Nonjudgmental/
Unconditional Acceptance of
People Different From Self
n Carolyn M. Porta
with Christine C. Andres, Carol J. Roth, Kelly Zaiser, and Renee Kumpula
Josie is a public health nursing student completing her final clinical hours before graduating. She and a
classmate have been volunteering in a school-based clinic. The school nurse has invited Josie to join her
on a home visit to check up on a student who has just given birth. Josie uses the GPS on her smartphone
to find the apartment; it is located in a part of the city she normally avoids. She carefully locks her car and
joins the school nurse in the apartment lobby. The client answers the buzzer, and they are invited upstairs
to the apartment. The unfamiliar hallway lighting and smells cause Josie to proceed cautiously. She hopes
to focus on what the school nurse accomplishes rather than on her own feelings of discomfort.
JOSIE’S NOTEBOOK
COMPETENCY #10 Demonstrates Nonjudgmental/Unconditional Acceptance of People
Different from Self
A. Listens to others in an unbiased, respectful manner
B. Promotes the expression of diverse opinions and perspectives
C. Identifies the role of diverse factors when selecting or designing public health interventions tailored
to specific individuals, communities, or systems
D. Interacts respectfully, sensitively, and effectively with individuals, families, and communities
Source: Henry Street Consortium, 2017
USEFUL DEFINITIONS
Acceptance: “To consider their patients’ culture and incorporate it in care” (Cioffi, 2003, p. 305) and the
“respect of another’s individual person and self-defined reality” (Porr, 2005, p. 189).
Nonjudgmental: “Being open to understanding cultural uniqueness and respect for individuals” (Pasco, Morse,
& Olson, 2004, p. 239). A nurse describes being nonjudgmental as she sought to “establish a… communion
into which I enter having cleansed myself of harmful bias through honest self-reflection; and, in which I exude
humility and openness” (Porr, 2005, p. 195).
Unconditional: “A form of respect that involves profoundness of feeling, treasuring, warm regard, [and]
solicitous concern” (Dillon, 1992, p. 120).
different timeframes, and it’s good to note when discrepan-
cies exist. In Figures 4.5 and 4.6, both MDH and CDC data
are reported for 2015, which offers a useful comparison. An
effective PHN tries to find the most comparable data possi-
ble but does point out discrepancies when comparisons are
made between incomparable data. Using data that are not
a perfect match is not wrong, but these differences must be
identified so that people can make informed decisions based
on the existing data. It might not be true that people can
make data say exactly what they want them to say, but it
certainly is possible to inadvertently or purposefully present
data in ways that might not be entirely accurate. Therefore,
PHNs need to spend time practicing how to present data in
meaningful, representative ways, and, equally vital, they
need to have the ability to interpret and critique any data
that are presented to them.
Data Comparison Between National
and Global Sources
To understand the context from which a client originates, a
PHN may be interested in disease incidence in other parts
of the world. The earlier PHN who graphed active TB cases
against latent TB cases may have found increasing numbers
of families from several parts of the world now living in her
community. Reviewing information from the World Health
Organization (WHO) will inform her of the distribution
of TB elsewhere. This information can then be applied to
determine communicable disease risk related to immigra-
tion patterns in her community.
Data as Population Trends
Equally valuable are data that demonstrate population
trends. These are most commonly presented in the form of
a population pyramid, which at a glance provides a picture
of population growth (see Figure 4.7). In this figure, the age
distribution of people in the U.S. is portrayed. Compared
with other years, one can visually see changing trends in
population age distribution. This could be valuable to
determining priorities for PHN interventions, particularly
A good example of this scenario is Lyme disease, which
is contracted through exposure to ticks. Lyme disease cases
between 1996 and 2016 have varied from 252 to 1,431 cases
in Minnesota and have steadily increased since 2002 (see
Figure 4.5). However, without being able to compare these
numbers to those of another state, it is difficult to determine
whether the problem is serious or relatively consistent with
national trends. The PHN investigating this issue might
look beyond state-level data to what is occurring nationally.
Review of national data provided by the CDC demonstrates
that Minnesota has one of the highest density areas of Lyme
disease, second only to states along the East Coast (see
Figure 4.6). The data in Figure 4.6 are from a Geographic
Information System (GIS) wherein a dot is placed within the
county of residence for each confirmed case of Lyme disease.
GIS is an example of a mapping tool that PHNs may use for
surveillance. (See “Innovative Data Collection: Maps and
Apps,” for more GIS information.) These data would sup-
port efforts by PHNs to bring attention to the problem and
to invest in preventive messages for Minnesotans regarding
the spread of Lyme disease.
Often data are not easily and perfectly comparable
between sources due to different years of reported data or
EVIDENCE EXAMPLE 4.3
Comparing Virtual and Outpatient Tuberculosis
Clinic Models of Care
In a recent study, the use of a virtual public health clinic was
compared with a traditional outpatient clinic for managing
tuberculosis in a Canadian province (Long, Heffernan, Gao,
Egedahl, & Talbot, 2015). The TB prevention and care model
was delivered through one virtual and two outpatient clin-
ics, which were subsequently assessed on 28 performance
indicators. Overall, one clinic type did not demonstrate
superiority to the other, which is promising for virtual or
tele-health models of healthcare delivery and management
for challenging public health concerns such as TB.
Addressing Asthma to Improve Health in Cities
GOAL 11 Nurses are on the front line globally for addressing asthma, which is the most common
chronic condition among children that can have long-term consequences when left undiagnosed and
undertreated. Nurses in Iceland and the United States developed an International School Nurse Care
Coordination Model that informs strategies addressing asthma at both the student and the school
levels, including symptom management, care coordination within and outside the school setting, and
broader educational strategies (Garwick et al., 2015). Collaborative efforts such as this offer promise of
achieving this SDG by recognizing where global challenges might be met with similar strategic models.
173CHAPTER 8 n Competency #6
TheCultureofHealthactionareasconsistofthefollowing:
n Making health a shared value is critical for govern-
ment, business, communities, and all individuals to
thrive, as we all are interdependent upon one another.
As Paul Wellstone once said, “We all do better, when we
all do better” (Wellstone.org, 1999, para. 7). Taking steps
to make health a shared value requires working within
the social environment and shifting mindsets to focus
on health as a collective, fostering a sense of commu-
nity and promoting civic engagement through activities
like voting and volunteering (RWJF, 2015; Trujillo &
Plough, 2016).
n Fostering cross-sector collaborations is necessary to
create a Culture of Health. If PHNs work alone or even
with others within public health or healthcare sectors,
they will not have the resources or power to create the
necessary changes to foster a culture where all people
can be healthy. Thus, cross-sector collaborations are
critical to bringing diverse groups and interests together,
like government, businesses/industry, education, health-
care and public health, and community organizations.
By incorporating each group’s knowledge, resources,
and strengths, cross-sector collaborations can have
greater influence and impact on the policies and envi-
ronments that influence population health, well-being,
and equity to build a Culture of Health (RWJF, 2015).
Factors found to facilitate effective partnerships include
the following (Campbell et al., 2015; Casey, 2008; Drahota
et al., 2016):
n Establishing trust, commitment, and respectful
relationships among partners
n Having mutually shared values, goals, and outcomes
n Sharing resources and balancing power and control
n Having effective, clear, and open communication and
decision-making
n Establishing clearly defined roles and a conflict-
resolution plan together
n Recognizing and building on strengths and assets of the
partners and individuals and communities
healthypeople.gov
Healthy
People
The Healthy People 2020 website offers
suggestions useful for collaboration and
building partnerships. On the website: 1) click
“Healthy People in Action,” 2) click “Stories from the Field,”
3) click two or three map points to read the featured story, and
4) identify the role of partnership in the success story. Then
consider how PHNs could use Healthy People 2020 goals,
tools, and resources as they collaborate with professionals and
communities.
Building a Culture of Health:
Partnership and Collaboration
An important skill for PHNs is learning how to develop
collaborative community partnerships to bring about com-
munity and systems change for improving health (Fawcett,
Schultz, Watson-Thompson, Fox, & Bremby, 2010; Towne &
Valedes, 2017). Collaborating to establish effective partner-
ships is essential for building a “Culture of Health.”
What is a Culture of Health? The Culture of Health is a
systems-level initiative that brings together all stakeholders
who aim to improve health outcomes. As coined by Robert
Wood Johnson Foundation (RWJF, 2015), a Culture of
Health is where all individuals, communities, and societies
can enjoy good health to grow, live, work, and play. Through
an extensive research process, RWJF developed the Cul-
ture of Health Action Framework, shown in Figure 8.2, as a
guide for how governments, organizations, and health pro-
fessionals can work together to build a culture that increases
population health, well-being, and equity. The four action
areas overlap and are interconnected; one action area in
particular focuses on collaboration and partnership (RWJF,
2015; Trujillo & Plough, 2016). As you read about each of the
four RWJF action areas, consider how important collabora-
tion and partnership is for each action area.
FIGURE 8.2 Culture of Health Action Framework
Source: © 2015, Robert Wood Johnson Foundation.
Used with permission.
EQUITY
EQUITY
ACTION AREA
2
FOSTERING
CROSS-SECTOR
COLLABORATION
TO IMPROVE
WELL-BEING
ACTION AREA
1
MAKING
HEALTH A
SHARED VALUE
OUTCOME
IMPROVED
POPULATION HEALTH,
WELL-BEING,
AND EQUITY
ACTION AREA
4
STRENGTHENING
INTEGRATION OF
HEALTH SERVICES
AND SYSTEMS
ACTION AREA
3
CREATING HEALTHIER,
MORE EQUITABLE
COMMUNITIES
‘‘
’’
The following section shows how PHNs accomplish the
work that is outlined in the essential services and core func-
tions and contribute to the well-being of populations. In a
survey of 57 PHNs working in local and state governments
and representing 28 states, they identified the amount of
time spent providing each of the essential services. The per-
centage of time spent on each essential service ranged from
7% to 14% (Keller & Litt, 2008). See Figure 7.2.
Dan remembers seeing the Public Health Core Functions in
his orientation manual—assessment, policy development,
and assurance. He says to Carol, “Let’s see if I understand
how this works.”
“For the measles outbreak, I can see assessment hap-
pening when we are identifying how many children in the
targeted age group live in our county. For policy develop-
ment, we are following the directives given by the CDC and
the state department of health for vaccine administration.
I can see how we are working with and through others to
ensure that as many children as possible have access to the
vaccine. Assurance occurs when we make sure the vaccine
is accessible to the population groups that need to be vacci-
nated and that the vaccine has been administered to them.”
Carol affirms Dan’s analysis of how the core functions
were represented in the response efforts to the measles out-
break. Dan then says, “I am not sure about all those essen-
tial services. Do PHNs conduct all ten in response to the
measles outbreak?”
Carol answers, “Let’s analyze how each of the essential
services occurs when our health department responds to the
measles outbreak. Let’s develop a handout to put into the
orientation manual to help everyone understand how we
are providing the essential services.”
See Table 7.4 for the handout that Dan and Carol developed.
Application of Ten Essential Services to
Measles Outbreak Response
A measles outbreak occurred in Minnesota in late March
of 2017. This was the worst measles outbreak in Minnesota
since 1990. A total of 79 cases were reported, which primar-
ily affected the Minnesota Somali community. All local
health departments in Minnesota had a role in prevent-
ing the spread of this infectious disease, involving activi-
ties such as active awareness and risk communication with
medical providers.
How Do Public Health Nurses
Use Statutory Authority?
Statutory authority refers to the statutes (laws) and rules
through which the government gives authority to agencies
to carry out specific duties. In the public health arena, PHNs
are responsible for adhering to public health laws that have
been enacted to protect and promote the health of commu-
nities. Public health laws may be federal, state, or local, but
many are implemented at the local level.
Public health law is often established in response to crit-
ical public health problems that affect populations. Mello
and colleagues (2013) identified three criteria for determin-
ing opportunities for establishing public health law: 1) the
EVIDENCE EXAMPLE 7.2
National Public Health Accreditation
In 2011, a national voluntary accreditation program for
local, state, territorial, and tribal leaders was established to
ensure accomplishment of the Core Functions and the Ten
Essential Services. The Public Health Accreditation Board
(PHAB) oversees the accreditation process. Participation
in the accreditation process helps health departments to
identify their strengths and weaknesses; establish quality
improvement strategies; communicate their accountability
to community members, stakeholders, and policymakers;
and be competitive in funding opportunities (CDC, 2017b).
FIGURE 7.2 Percentage of PHNs’ Time Dedicated to Essential
Services (n = 57)
14%
Inform, educate,
& empower
7%
Research
8%
Develop
policies &
plans
8%
Mobilize
11%
Evaluate
11%
Diagnose &
investigate
11%
Assess health
status
11%
Assure
12%
Link
7%
Enforce laws
& regulations
153CHAPTER 7 n Competency #5
TABLE 7.4 Ten Essential Services: Measles Outbreak Response by Local Public Health
Essential Service Application Example
1. Monitor health Monitored data on those at risk due to being unvaccinated, and monitored clinic and hospital data
of reported cases provided by Minnesota Department of Health
2. Diagnose and Investigate Communicated with summer camps and daycares on symptoms to watch for and resources
available
3. Inform, Educate,
and Empower
Worked with local media outlets and sent a Health Advisory to medical providers on the outbreak,
including what to watch for and report
4. Mobilize Community
Partnerships
Worked with Somali community leaders and organizations to reach the at-risk population
5. Develop Policies Adopted policies from CDC and state department of health on vaccine recommendations
6. Enforce Laws Activated response by utilizing the Health Department Emergency Response Plan
7. Link to/Provide Care Coordinated with the Department of Human Services regarding childcare licensing regulations
and potential changes needed due to outbreak
8. Ensure Competent
Workforce
Provided training for staff to assist with contact investigation and follow-up to ensure competence
for roles and responsibilities
9. Evaluate Once outbreak was over, a “hot wash” was conducted to document the response work and lessons
learned
10. System Management
and Research
CDC vaccine information posted on website, which included basic information and vaccination
guidance
law targets a significant public health problem, 2) factors
contributing to the public health problem are understood
well enough to change behavior through law, and 3) a feasi-
ble intervention can be implemented.
Public health law is potentially an effective tool for
improving population health outcomes. However, compet-
ing interests and values about laws may affect individual
choice. This adds complexity to enacting laws that address
threats to individual and population health. It is important
to provide objective and timely evidence to support legal
policy that contributes to improving population health.
Major trends in public health law and practice include the
following focus areas (Hodge et al., 2013):
n The Affordable Care Act
n Emergency legal preparedness
n Health information privacy and data sharing
n Tobacco control
n Drug overdose protection
n Food policy
n Vaccination requirements and exemptions
n Sports injury law and policy
n Public health accreditation
n Maternal and child health
Public health laws influence funding for public health
programs. For example, emergency preparedness programs
received major funding following bioterrorism events and
threats. Funding increases the number of public health prac-
titioners employed in emergency preparedness programs.
Public health laws also protect the health of the public.
PHNs need to understand public health law and how it pro-
tects individual, family, and community safety. Laws con-
cerned with public health include public health nuisance;
quarantine; mandated reporting of communicable disease;
mandated reporting of suspected abuse and neglect of chil-
dren, the disabled, and the elderly; and commitment. See
examples of local public health laws in Table 7.5.
For PHNs who practice in school settings, a federal
law titled the Family Educational Rights and Privacy Act
(FERPA) protects the privacy of student educational records
(U.S. Department of Education, 2015; U.S. DHHS and the
U.S. DoE, 2008). When the school contracts for school nurs-
ing services from a community agency, the school nurse is
obligated to follow the school data privacy policy for educa-
tional records (Association of State and Territorial Health
Officers [ASTHO], 2015).
The Network for Public Health Law (https://www.
networkforphl.org/) compiles information and resources
about public health law at all levels of government. It iden-
tifies primary legal issues and offers technical assistance for
a variety of topics.
14 PART I n Foundational Concepts for Public Health Nursing Practice
To make a difference for these families and others in
their inner-city neighborhood, PHNs might carry out the
following interventions:
n Refer families who are eligible for food benefits and
nutrition services to Women, Infants, and Children
(WIC)—individual/family level of practice .
n Work with a community action council to make its
members aware of problems in their inner-city neigh-
borhood and assist them with taking action to obtain
bus service from the neighborhood to a shopping center
or supermarket—community level of practice .
n Help form a coalition of nonprofit organizations and
businesses to bring a cooperative store or other full-
service grocery store to the neighborhood—systems
level of practice .
Table 1 .5 summarizes the three levels of PHN practice
and provides examples of how public health nursing is car-
ried out at these levels . These are all actions that you as a stu-
dent or a newly practicing public health nurse can also take .
TABLE 1.5 Levels of Public Health Nursing Practice
Individual/Family Level Examples
“Population-based, individual-focused practice changes knowl-
edge, attitudes, beliefs, practices, and behaviors of individuals .
This practice level is directed at individuals, alone or as part of
a family, class, or group . Individuals receive services because
they are identified as belonging to a population at-risk” (MDH,
2001, p . 5) .
n Make home visits to newborns and their parents .
n Teach hand-washing to a first-grade class .
n Assess for the presence of lead-based paint in a home with
preschool children .
n Develop a fall-prevention plan for an elderly person living
alone .
Community Level Examples
“Population-based, community-focused practice changes com-
munity norms, community attitudes, community awareness,
community practices, and community behaviors . They [PHNs]
are directed toward entire populations within the community
or occasionally toward target groups within those populations .
Community-focused practice is measured in terms of what pro-
portion of the population actually changes” (MDH, 2001, p . 4) .
n Write a letter to the editor of a local paper to stress the
value of home visits to parents of newborns .
n Create a billboard about the hazards of lead-based paint .
n Participate in a community “town hall” meeting to make
the community aware of safety hazards for elderly people
living alone .
Systems Level Examples
“Population-based, systems-focused practice changes organiza-
tions, policies, laws, and power structures . The focus is not directly
on individuals and communities but on the systems that impact
health . Changing systems is often a more effective and long-lasting
way to impact population health than requiring change from every
single individual in a community” (MDH, 2001, pp . 4–5) .
n Meet with legislators to advocate for reimbursement for
home visits with families of newborns .
n Develop a hand-washing program at an elementary school .
n Teach real-estate agents how to recognize lead-based paint
in a home .
n Develop a fall-prevention protocol for nurses working with
the elderly in the community .
Health Determinants
Public health nurses consider the multiple factors that
determine the health of their clients . Health determinants
are factors that influence the health of individuals, families,
and populations . Health determinants can have a positive or
negative influence on health . Table 1 .6 presents examples of
protective and risk factors at all three levels of practice for
communicable disease in childhood:
n Protective factors are health determinants that pro-
tect a person from illness or assist in improving the
person’s health .
n Risk factors are health determinants that contribute
to the potential for illness to occur or to a decrease in
health or well-being .
Just as holistic nursing practice focuses on the whole,
public health nursing focuses on the whole by identifying
all of the factors that influence the health of individuals,
families, and communities . To ignore this wholeness of the
living condition is to ignore many factors that impact health
and the ability of public health nurses to promote health .
Biological, behavioral, and environmental factors interact
17CHAPTER 1 n Introduction to Public Health Nursing Practice
‘‘
’’
Levels of Prevention
The levels of prevention (primary, secondary, and tertiary)
provide a framework for health-promotion and disease-
prevention efforts in the stages of the natural history of dis-
ease (Leavell & Clark, 1958; Stanhope & Lancaster, 2008) .
The health-promotion progression from primary to sec-
ondary to tertiary prevention provides a framework for
population-based public health nursing interventions at all
levels of public health nursing practice (MDH, 2001; Skemp
et al ., 2016) . It is important to determine the health status
of individuals/families, communities, and populations and
to determine the level of prevention for specific health con-
cerns to implement the appropriate interventions . Figure 1 .5
provides an overview of the stages of health, the levels of
prevention, and intervention approaches .
Although the focus of public health nursing is primary
prevention, public health nursing practice encompasses
all three levels . In contrast, within the hospital setting,
the focus of most nursing care is on ill patients and their
family members, and nurses more often provide secondary
and tertiary prevention but may also provide some primary
prevention . Table 1 .7 shows the definition of each level with
examples .
healthypeople.gov
Healthy
People
Healthy People, a program of the U.S.
Department of Health and Human Services,
has established science-based benchmarks
and 10-year national objectives for improving the health of all
Americans. Healthy People 2020 is the third set of national
health priorities identified over the last 3 decades. Its vision is “a
society in which all people live long healthy lives” (U.S. DHHS,
n.d.-b, p. 1). The mission and goals are displayed in Table 1.8.
This national program seeks to involve all Americans by encour-
aging community and organizational collaboration, empowering
individuals to make informed health decisions, and measuring
the outcomes of prevention activities (U.S. DHHS, n.d.-b).
“Okay! Now I understand why public health nurses do what
they do, but I am still not clear about what I am supposed
to do!” Albert states in an exasperated tone of voice.
Sia responds, “I guess we have to assess our clients’
health status, identify their health determinants, and
develop a plan of care that builds on their protective factors
and reduces their risk factors. Now it makes sense that we
would be mostly listening, teaching, and counseling. Did
you know that the words listen and silent have the same
letters? I guess we need to use silence to listen to our clients!”
Abby states, “I really like all the secondary and tertiary
prevention interventions that I do in the hospital setting, so
I am afraid I am going to get bored working in the commu-
nity. I can only sit and listen for so long. I like action!”
Albert reflects, “Primary prevention doesn’t have to
mean you are not doing anything. Just because there isn’t
already an illness or disease doesn’t mean there isn’t work
to do. Primary prevention is the way that we can identify
health determinants and make an impact. Our instructor
says we can apply public health nursing in any nursing
practice setting. Maybe I will think about how I can use
everything I learn in my community clinical in my hospital
practice. But, who knows, maybe I will decide to become a
public health nurse!”
Sia asks, “I understand what we are supposed to focus
on when we work with individuals and families, but I am
not sure how identifying their health statuses and health
needs fits in with the concept of population-based practice.
I guess I need to talk to my preceptor about how our home
visits fit in with the priority health needs of our community.
How do I know whether what we are doing reflects what the
community really wants public health nurses to do?”
FIGURE 1.5 Stages of Health and Disease and Levels of Prevention
Key
Interventions
Health
Promotion and
Prevention
Screening,
Diagnosis, and
Treatment
Rehabilitation,
Remediation,
Maintenance
Level of
Prevention
Primary Secondary Tertiary
Stage
of Health
Healthy
Early Disease
or Injury
Chronic
Disease

Light Right, by Joe Levine and Brad Bartholomew
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Storytellers: A Photographer’s Guide to Developing Themes, by Jerod Foster
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Adventure Sports Photography, by Tom Bol
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Sketching Light, by Joe McNally
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The Passionate Photographer, by Steve Simon

Photographing Nature, by Ralph A. Clevenger
Flash! And you’re
in control
5
05_PN_r3.indd 92 10/2/09 12:37:52 PM 05_PN_r3.indd 93 10/2/09 12:37:54 PM
94 PHOTOGRAPHING NATURE
Light at 1/20,000 of a second
Photographers either love using flashes, or avoid them completely. I think
the avoidance comes from not understanding how to use a flash. There’s
a lot to understand—more than I can fit into just one chapter. But once you
understand the reasons for using a flash, actually learning to use them
comes down to reading the manual, checking out some video tutorials,
and practicing—a lot. The appendix lists some of my favorite websites
related to flash technique. They’re not specific to nature photography, but
are great places to learn about using your flash.
Why use a flash? Three reasons: to control contrast, to freeze mov-
ing subjects, or because you don’t have enough light to take a picture
(Fig. 5.1).
Since your camera can’t render contrast the way your eyes can, you
need to add light to the shadows to get the resulting image to look natu-
ral. If you’re close to your subject, the little pop-up flash on top of the
camera will work fine. But to fill in the shadows on a subject more than
a few feet away, you’re going to need a separate through-the-lens (TTL)
flash that’s dedicated to your camera system. Using a flash mounted on
the camera works fine in some fill-flash situations, but if you really want to
make spectacular images you have to get that flash off the camera.
Fig. 5.1 The Oregon Zoo’s Great
Northwest exhibit puts visitors below
ground, giving them unique views of
magnificent gray wolves. It’s winter,
and a shaft of sun is backlighting this
male. I added flash so you can see his
face, and put a catchlight in his eyes.
Portland, Oregon. (Nikon F4, ISO 200,
400 mm lens, on-camera flash, tripod,
Kodak Ektachrome 200, exposure
unrecorded, captive.)
Use your flash to make images that reflect what
you saw, not just what was there.
05_PN_r3.indd 94 10/2/09 12:37:54 PM
chapter 5: FLASH! ANd yOU’RE IN cONTROL 95
05_PN_r3.indd 95 10/2/09 12:37:56 PM
All-day shooting
Wild areas such as meadows, forests, swamps,
streams, and mountains contain so many close-up
subjects that the hardest part is choosing what to pho-
tograph. If you’re curious and patient, you’ll find the
right subject. A great thing about close-up shots is that
you can capture them at any time of the day, all day.
Many flowers need a lot of sun to open fully, so you
can work with them at midday, when the light is hard.
Others will bloom in sunlight or shadow (Fig. 6.2).
A lot of close-up images can be shot with artificial
light; for instance, the small green parrot snake in the
chapter opener. On a trip with friends to Costa Rica,
we spent a few days in the Monteverde cloud forest.
We didn’t have time to find all the amazing creatures in
the wild, so instead we went to a nearby herpetarium
(a zoo for reptiles and amphibians). The parrot snake
was in a terrarium lit by fluorescent light. Using a high
ISO and 105 macro lens, I focused on those dark eyes,
creating a strong relationship between the snake and
the viewer. All the subjects I needed were indoors, so I
could shoot close-ups all day.
Even in seemingly lifeless places like the desert,
you’ll find amazing, tiny things. Some of the smallest
flowers I’ve ever seen just appeared out of the sand
after a brief rainfall in the desert. Plants have seasonal
variations. be sure to do your research on regional
growing seasons, so you can take advantage of the
opportunities each environment may provide—like
one of those California spring wildflower seasons
when the ground looks like someone splashed paint
out of an airplane (Fig. 6.3 and 6.4).
tip I don’t like getting my belly wet or stickered, so I
always carry a big white trash compactor bag to put on
the ground under me.
Fig. 6.2 It rains a lot during the summer on the Alaskan
tundra where I found this fireweed flower. The soft light and
green background make for perfect flower photography.
Staying dry is a big concern here. Not you—you work
fine whether wet or dry. It’s the camera that has to stay
dry, so I used a camera raincoat. Denali National Park,
Alaska. (Nikon D200, ISO 200, 105 mm macro lens, 1/3x
magnification, handheld, 1/250 sec. @ f/4.)
06_PN_r3.indd 114 10/2/09 12:47:50 PM
chapter 6: WET-bEllY PHOTOGRAPHY 115
 Fig. 6.3 Harsh environments like mountains and deserts
are hard on plants. This Wallace’s woolly daisy grows only
about an inch high—so low to the ground that people call
them “belly flowers.” Mojave Desert, California. (Nikon D100,
ISO 200, 105 mm macro lens, 3/4x magnification, handheld on
beanbag, 1/200 sec. @ f/11.)
 Fig. 6.4 California poppies only open between 10 a.m. and
3 p.m.—very convenient if you don’t like getting up early. This
show of wildflowers is in the Antelope Valley Poppy Preserve,
in the Mojave Desert north of Los Angeles, California. The
poppy bloom is different each year and depends a lot on when
the rains come. A great website called Desert USA (listed in
the appendix) has wildflower reports. (Nikon D100, ISO 200,
14 mm lens, tripod, 1/250 sec. @ f/14.)
06_PN_r3.indd 115 10/2/09 12:47:52 PM
Extension tubes
If you don’t have a true macro lens, you can use an extension tube to get
greater magnification. These hollow metal rings come in different lengths
and attach between the camera and lens. Using an extension tube allows
any lens to focus closer.
When you add an extension tube, you shift the focus range of the lens
closer. For example, if your regular 50 mm lens can normally focus from
1.5 feet to infinity, adding a 50 mm extension tube allows it to focus from
about 3 inches to about 10 inches. You’ve turned your normal lens into
a close-focus lens that can do life-size magnification. You can’t focus at
infinity anymore, but who cares? We’re doing macro photography.
You can use extension tubes with normal lenses, telephoto lenses, and
even zoom lenses. before you buy extension tubes, however, make sure
that they work with your lenses.
Diopters (close-up filters)
Another way to make a normal or zoom lens focus closer is to screw a
close-up diopter onto the front of the lens. You can use diopters on any
lens; the key is to buy a large-diameter diopter, such as a 72 mm, and then
get a step-up ring so you can screw the 72 mm diopter onto the front of
your lenses. Diopters come in different powers and quality. For the best
quality, get a two-element diopter. They cost more, but produce better
images by correcting more optical aberrations. For a great macro setup,
put the Canon 500D close-up diopter on a 70–300 zoom lens. This will
get you 3/4x. With just one lens and a close-up filter, you can get close
enough to that butterfly or lizard to fill the frame (Fig. 6.9).
Lighting
Adding light to what’s already there can enhance the color and mood of
your photos. You can use a small flash as the main light or to add fill light.
And it doesn’t have to be a flash. If you’re shooting in darkness, try using a
flashlight, as I did with the red-eyed tree frog in Fig. 6.10.
In many macro situations, you’re so close to the subject that you have
to get your flash off camera and point it at the subject if you want anything
lit. When working in the field, I typically use one off-camera TTl flash.
Fig. 6.9 A friend of mine, Dennis
Sheridan, is an animal wrangler who
works with reptiles, amphibians, and
insects. Some of his animals are used
in movies. This is one of his great
reptiles, a leopard gecko from the
Middle East. Many people have these
animals as pets. Give you any ideas for
where to find exotic subjects? (Nikon
D300, ISO 200, 105 mm macro lens,
1/2x magnification, off-camera TTL
flash with diffusion, tripod, 1/40 sec.
@ f/16, captive.)
06_PN_r3.indd 118 10/2/09 12:48:01 PM
chapter 6: WET-bEllY PHOTOGRAPHY 119
Fig. 6.10 This red-eyed tree frog is another creature we
found at the herpetarium in Costa Rica’s Monteverde cloud
forest. These nocturnal frogs are active mainly at night; the
herpetarium keeps the terrarium dark so you can see the frogs
moving around, rather than sleeping. (Nikon D2X, ISO 400,
105 mm macro lens, 1/2x magnification, lit with flashlight,
tripod, 1/10 sec. @ f/11, captive.)
06_PN_r3.indd 119 10/2/09 12:48:03 PM

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