NSG_221_Midterm_Study_Guide___Complete.docx

NSG 221 Community Health ConceptsMidterm Study Guide
NSG 221 Community Health Concepts
Midterm Study Guide
To help you prepare for the exam, use power points, audios, Knightsburg Activities, IHI Intro to
Population Health, and readings to utilize the following study guide. This is not intended to be
inclusive. Know all key terms (vocabulary words) and objectives for each chapter. I encourage
you to form study groups and use this as a guide for discussion. There will be 26 questions
(worth 50 points) - matching, multiple-choice, & select-all-that-apply.
Module 1: Nies Ch 1
• Define and discuss the focus of public health.
o Health promotion, preventative care, and cost reduction. Nurses in public health have
increased, but in hospitals have declined.
o Often described as the art and science of preventing disease, prolonging life, and
promoting health through organized community efforts to benefit each citizen.
o Mission? Get everyone basic necessities such as healthcare and adequate income.
Collective burdens with this in mind.
o To synthesize nursing practice with public health practice.
o Goal? Preserve health of community and surrounding populations.
o Health is a RESOURCE for every day life, not an OBJECTIVE for living.
▪ Health defined by WHO: the extent to which an individual or group is able, on
the one hand, to realize aspirations and satisfy needs; and, on the other hand, to
change or cope with the environment. Health is, therefore, seen as a resource
for everyday life, not the objective of living, it is a positive concept emphasizing
social and personal resources, and physical capacities
• Discuss determinates of health and indicators of health and illness from a population
perspective.
o Identifying populations at risk rather than treating
illnesses after.
o Determinants of health – health status is focused
on a lot of factors
▪ Healthcare access
▪ Economic conditions (poverty)
▪ Social & environmental issues (smoking,
violence, lead paint, etc)
▪ Cultural practices
o Essential to understand so that we can recognize
how they interact to lead to disease, death, and
disability.
• List the three levels of prevention and give examples of each.
o Primary Prevention – prevents problems before they occur. Health promotion and
protection.

▪ Primary prevention activities are aimed at preventing a problem
before it occurs, such as holding a nutrition program at a school
cafeteria.
o Secondary Prevention – early detection and intervention or early dx and tx.
▪ Secondary prevention is implemented after a problem occurs but
before signs and symptoms appear. EX: A program to identify
and treat persons exposed to tuberculosis within two weeks of
exposure
o Tertiary Prevention – correct and prevention of deterioration of a diseased space. Helps
limitation of disability and rehab.
▪ Tertiary prevention is aimed at preventing complications or to
keep health problems from getting worse. Alcoholics
Anonymous and an exercise program for stroke victims are
examples of tertiary prevention.
o Spending money on a cure DOES NOT improve the health of a population. Spending
money on prevention DOES.
o Applied to individual, family, group, or community.
• Explain the differences between public/community health nursing practice and community-
based nursing practice
o Public Health nursing practice – uses strategies from nursing, social, and public health
sciences to promote/protect health of populations.
▪ Practice is a systematic process for evaluating/implementing knowledge
▪ Results used to promote health/prevent disease
▪ Responsibility – population as a whole.
o Community Health Nursing Practice – synthesis of nursing practice and public health to
promote/preserve the health of populations.
▪ General/comprehensive care, NOT EPISODIC.
▪ Holistic approach to management of healthcare
▪ Responsibility to population as a whole, but care is focused on individuals and
groups.
o Community-Based Nursing Practice – focus on individuals and families where they live
and work. Care is setting specific and focused on chronic and acute care. (ex: home health
nursing, outpatient nursing, or ambulatory setting)
o Population-focused nursing – focuses on entire population. Assess health status of
population, consider broad health determinates, all levels of prevention, and intervenes
in community systems, individuals, and families.
▪ Concentrates on specific groups of people and focuses on health promotion
and disease prevention, regardless of geographic location
• Describe the purpose of Healthy People 2020 and give examples of the topic areas that
encompass the national health objectives.
o Goal 1: increase quality and years of healthy life
o Goal 2: eliminate health disparities
o HP2020 has focus areas divided into objectives, which guide health promotion activities
and can be used to aid in community-wide initiatives.
▪ Access to health services
▪ Preventative health services
▪ Environmental quality

▪ Injury & violence
▪ Maternity, infant, child
▪ Mental health
▪ Nutrition
▪ Physical activity and obesity
▪ Oral health
▪ Reproductive/sexual
▪ Substance abuse and tobacco
• Discuss community/public health nursing practice in terms of public health’s core functions and
essential services.
o Assessment – regular collection/analysis/info sharing about health conditions, risks,
resources in a community. Helps monitor health status, identify/diagnose/prevent
problems, research for new insights and solutions.
o Policy development – use of info gathered during assessment to develop local and state
health policies and direct resources toward the policies. Inform, educate, empower
people about health issues. Mobilize partnerships in community. Develop plans that
support health efforts.
o Assurance – focuses on availability of necessary health resources in the community.
Maintain ability of public health agencies and private providers to manage day-to-day
situations and respond to critical situations/emergencies. Enforces laws/regulations that
ensure safety. Link to health services, ensure provision of healthcare.
• Discuss community/public health nursing interventions as explained
by the intervention wheel.
o Provides a framework for community/public health nursing
practice
o Levels aimed at improving public health
o Three levels:
▪ Community
▪ Systems
▪ Individual/family
o Seventeen public health interventions in five areas
• Vocabulary
o Population – a collection of individuals who have one or
more personal or environmental characteristic in common.
o Aggregates – are subgroups or subpopulations that have some common characteristics
or concerns
o Public health – the practice of preventing disease and promoting good health within
groups of people, from small communities to entire countries.
o Primary prevention – prevention before they occur. Includes health promotion and
protection
o Secondary prevention – early detection/intervention or early dx and tx.
o Tertiary prevention – the correction and prevention of deterioration of a diseased state
o Community – group or collection of locally based individuals interacting in social units
and sharing common interests, characteristics, values and/or goals.
o Healthy People 2020 –
o Goal 1: increase quality and years of healthy life
o Goal 2: eliminate health disparities.

o HP2020 has focus areas divided into objectives
▪ Objectives can health guide health promotion activities and can be used
to aid in community-wide initiatives.
o HP2020 Leading Health Indicator Topics include access to health services,
clinical preventative services, environmental quality, injury and violence,
maternal/infant/child health, mental health, nutrition/physical
activity/obesity, oral health, reproductive and sexual health, social
determinants, substance abuse, and tobacco.
o Core Public Health Functions
▪ Assessment: the regular collection, analysis, and information-sharing about
health conditions, risks, and resources in a community. It helps to monitor
health status to identify community health problems, diagnose and investigate
health problems and health hazards in the community and provide research for
new insights and innovative solutions to health problems.
▪ Policy development: use of information gathered during assessment to develop
local and state health policies and to direct resources toward those policies. It
helps to inform, educate, and empower people about health issues. It helps to
mobilize community partnerships to identify and solve problems. Helps to
develop policies and plans that support individual and community health
efforts.
▪ Assurance: focuses on the availability of necessary health services throughout
the community. It includes maintaining the ability of both public health agencies
and private providers to manage day-to-day operations and the capacity to
respond to critical situations and emergencies. Assurance enforces laws and
regulations that protect health and ensure safety. This links people to personal
health services and ensures the provision of health care when otherwise
unavailable.
o Public health nursing: described as synthesis if public health and nursing practice.
▪ Classic definition: Public health nursing may be defined as a field of
professional practice in nursing and in public health in which technical
nursing, interpersonal, analytical, and organizational skills are applied to
problems of health as they affect the community. These skills are applied
in concert with those of other persons engaged in health care, through
comprehensive nursing care of families and other groups and through
measures for evaluation or control of threats to health, for health education
of the public, and for mobilization of the public for health action.
o Community health nursing: as the synthesis of nursing practice and public health
practice applied to promoting and preserving the health of population.
• Prevention Levels Matching
• Core Functions of Public Health Nursing Activity
• Review Module 1 Self-Assessment
Module 2: Nies Ch 2
• Describe the impact of aggregate living on population health

o Stages: hunting and gathering, settled villages, preindustrial cities, industrial cities, and
present stage
o Increasing population & population density have resulted in environmental changes that
caused ecological imbalance. This has impacted the state of health.
▪ In these stages, growing populations, increased population density, and
imbalanced human ecology resulted in changes in cultural adaptation. In each
stage, humans created ecological imbalance by altering their environment to
accommodate group living.
o Stages overlap and time periods are widely debated.
• Understand historical events that have influenced population health
• Identify approaches to population health promotion from prerecorded historic to present times
o Prerecorded historic times (before 5000 BCE) – crude efforts, voodoo, isolation,
fumigation.
o Classical times (3000 to 200 BCE) – drainage systems, pharmaceuticals, embalming the
dead, laws managing cleanliness and disease.
o Middle ages (500 BCE to 1500 CE) – priests/monks primary healthcare. Magic and
religion. Church enforced biblical health codes like leper houses or isolation.
Communicable diseases were rampant and pandemic. Public health measures (building
wells, fountains, streets, etc).
▪ Diseases at the time: measles, smallpox, diphtheria, leprosy, and bubonic plague
o Renaissance (15th
, 16th
, 17th
centuries) – population growth and migration was HUGE.
Microscopic organisms discovered. Elizabeth poor law.
▪ Elizabethan Poor Law – enacted in 1601. Held church parishes responsible for
providing relief for the poor.
o 18th
century – sanitation issues due to industrialization, poor children forced into labor.
Smallpox vaccines.
o 19th
century - Diseases flourished! Killing thousands. Life expectancy of the poor was
bad, which resulted in a board of health.
▪ In the nineteenth century, attention was called to unsanitary
conditions that resulted in health disparities that shortened the
life span of the laboring class in particular. Death rates were
high. Prevailing concerns included child welfare, factory
management, education, and care for the elderly, sick, and
mentally ill. Clean water, sewers, fireplugs, and sidewalks
emerged as a result.
• Compare the application of public health principles to the nation's major health problems at the
turn of the twentieth century (i.e., acute disease) with that at the beginning of the twenty-first
century (i.e., chronic disease)
• Describe two leaders in nursing who had a profound impact on addressing aggregate health
o Florence Nightingale & Lillian Wald
• Discuss major contemporary issues facing community/public health nursing and trace the
historic roots to the present
o In England in 1850s, Rathbone/Nightingale worked to educate “health nurses” in 1859
o In US, visiting nurses in 1877, henry street settlement in 1893.
• Vocabulary
o Florence Nightingale - (1820-1910) Concern for environmental determinants of health.
Emphasis on sanitation, community assessment, and analysis. Use of graphically

depicted statistics & comparable census data. Political advocate on the behalf of
aggregates. Education reform for nurses.
o Lillian Wald - (1867-1940) Established Henry Street Settlement in 1893 (along with Mary
Brewster). Played an important role in establishing public health nursing in the U.S.—
later called “Visiting Nurses Association of NYC.” Role of Henry Street Settlement was
“one of helping people to help themselves.” The Children’s Bureau and the Social
Security Act Legislation formed as a result of these efforts. In 1912, the National
Organization of Public Health Nursing was formed, and Lillian Wald was elected
president.
o Elizabethan Poor Law - (in 1601) placed care for the poor under the guidance of local
parishes.
o House on Henry Street - a direct nursing service in New York in 1893. Their philosophy
was to meet the health needs of aggregates and help people to help themselves.
o Edward Jenner - developed a vaccine for smallpox
o Evolution of health in Western populations – stages in disease history (aggregate impact
on health) Interrelationship between individual’s health, environment, nature, and size
of aggregate as each of these has an effect on population health.
• Hunting and gathering (before 10,000 BC): people probably suffered from
parasites such as lice and pinworms, insect bites and related illnesses. There
were few contagious diseases due to the lack of interaction.
o Paleolithic, old stone age, nomadic
• Settled Villages (10,000-6,000 BC): Began when small groups of people
began to settle together in permanent dwellings. Zoonosis: also known as
diseases that are capable of being passed from animals to humans, nutrient
deficiencies, and problems related to agrarian lifestyle were common. Waste
disposal and water availability were becoming problems.
• Pre-industrial cities (6,000-1,800 BC): waste disposal and the availability of
clean water supply became increasingly problematic. As a result, diseases
such as cholera and plague were common. The incidence of other
communicable diseases increased.
o Prior to the 18th
century
• Industrial cities (1,700-1,800 AD): Industrialization produces large amounts
of industrial waste that resulted in heavy air and water pollution and harsh
working conditions. Epidemics of infectious diseases such as tuberculosis,
diphtheria, smallpox, and measles proliferated.
o Include the 18th
-19th
centuries The Industrial Cities Stage
took place in the eighteenth and nineteenth centuries.
Increased industrial wastes, air and water pollution,
and harsh working conditions took a toll on health.
There was an increase in respiratory diseases such as
TB, pneumonia, and bronchitis and epidemics of
infectious diseases such as diphtheria, smallpox,
typhoid fever, typhus, measles, malaria, and yellow
fever.

• Present period (1,900-2,000 AD): During this time, sedentary lifestyles and
negative, personal behaviors, such as smoking, and substance abuse have
had adverse effects on health. Dietary changes and individual behaviors
have produced increase in bowel diseases, venous disorders, and heart
disease. An increase in some communicable diseases associated with
overcrowding have also been seen.
o From the 20th
century until now
o Endemic – diseases that are always present in population (e.g. colds and pneumonia)
o Epidemic – diseases that are not always present in a population but flare up on occasion
(e.g., diphtheria and measles)
o Pandemic - the existence of diseases in a large proportion of the population—a global
epidemic (e.g., HIV, AIDS, and annual outbreaks of influenza type A).
Module 3: Nies Ch 3
▪ Differentiate between upstream interventions, which are designed to alter the precursors of
poor health, and downstream interventions, which are characterized by efforts to modify
individuals' perception of health
o Upstream Interventions – looking at the root cause and trying to prevent it. Figuring out
who is pushing into the river and stopping it. Modifying factors that would decrease
health before they do. Identify aggregates at risk for TB, instituting measures to improve
living/nutrition, research for prevention/tx of TB. PRIOR to disease.
o Downstream Interventions – rescuing victims (correcting problem after it has occurred…
victim already in river, pulls him out). Short term, individual interventions. Testing,
treating, providing education for TB.
▪ Describe different theories and their application to community/public health nursing
▪ Critique a theory in regard to its relevance to population health issues
▪ Explain how theory-based practice achieves the goals of community/public health nursing by
protecting and promoting the public's health
▪ Vocabulary
o Health Belief Model (microscopic) - resulted from the desire to understand factors that
influence preventative health behaviors. An assumption of the model is that a major
determinant of preventative health behavior is the avoidance of disease. The model was
not designed to be generalized across disorders. So, actions that relate to preventative
health behaviors for each disease differ from one another. The HBM is narrow in scope
and places the burden of action exclusively on the client. It assumes that the only clients
who will fail to act are those who have negative perceptions of the specific disease or
the recommended health action. Interventions are generally focused on the alteration of
a patient’s perspective and are based on the individual.
o Milio’s Framework for Prevention (macroscopic) - involves the inclusion of economic,
political, and environmental health determinants and is broad in range. It relates the
ability of an individual to improve health behavior and society’s ability to provide
options for healthy choices that are accessible and socially desirable. The range of

choices available are shaped by government and private policy decision. Health deficits
result from an imbalance between a population’s health needs and its’ health sustaining
sources. To improve health status, health promoting choices must be readily available
and less costly than health damaging options. The range of health promoting or health
damaging choices available to individuals is affected by their personal resources such as
awareness, knowledge and beliefs, money, time, and other priorities as well as societal
resources which include availability and cost of health services, environmental
protection, shelter, etc.
o Self-Care Deficit Theory (microscopic)- based on the premise that nursing is a response
to one’s incapacity to care for oneself because of one’s health. Nursing assumes the role
of providing some or all self-care activities on the behalf of the patient. The concepts of
self-care, self-care deficit, and self-care agency are microscopic and difficult to apply to
populations.
o Upstream Thinking - examining the root cause of poor health. Upstream interventions
focus on preventing the problem before it happens. Upstream interventions focus on
modifications of economic, environmental, and political factors to improve the health of
the community. Examples of this include identifying aggregates at risk for the
development of tuberculosis, instituting measures to improve living conditions and
nutrition for those at risk and encouraging continuing research for new drugs to prevent
and treat diseases.
o Community health problems – microscopic, macroscopic
▪ Microscopic: individual, and sometimes family, response to health and illness.
Often emphasizes behavioral responses to individual’s illness or lifestyle
patterns. Nursing interventions are often aimed at modifying individual’s
behavior by changing his or her perceptions of belief systems. In an archery
analogy, the microscopic approach targets only the bullseye.
▪ Macroscopic: examines interfamily and intercommunity themes in health and
illness. Delineates factors in the population that perpetuate the development of
illness or foster the development of health. Emphasizes social, economic, and
environmental precursors of illness. Nursing interventions may include
modifying social or environmental variables. May involve social or political
action. More comprehensive and more suited for populations. The nurse
considers environmental, demographic, social and economic factors when
planning intervention. The macroscopic approach targets both the bullseye and
surrounding concentric circles for intervention.
o Healthy People 2020 - objectives provide health professionals with 28 focal areas that
address specific diseases, care systems, and cross-cutting issues in public health. Each of
the focal areas specified by CDC and in the HP2020 documents encompass a complex
and multifaceted problem – one that can only be addressed by applying macroscopic
theories. By thinking about the root causes of health problems, nursing efforts are
directed toward the antecedents of poor health and lost opportunities. For example, the
Social Determinants of Health topic area is designed to identify ways to create social and
physical environments that promote good health.

▪ Review Module 3 Self-Assessment
Module 4: Nies Ch 4
• Discuss various theories of health promotion, including Pender's Health Promotion Model,
the Health Belief Model, the Transtheoretical Theory and the Theory of Reasoned Action
(p55 Nies)
o Pender’s Health Promotion Model – looks at biopsychosocial factors that influence
others to pursue health prevention activities. Does not include threat as motivator.
o Health Belief Model – the basis for most health promotion/prevention today.info
won’t make people act. They must know what to do and how to do it in order to.
And the info must be related directly to their needs. Constructs? Perceived
seriousness, susceptibility, benefits of tx, barriers to tx, cues to action, and self-
efficacy.
o Transtheoretical Model – combines several different theories. Change is difficult
even for those that are motivated. Ex. Change can be unpleasant (exercising),
require giving up pleasure (eating desserts), be painful (insulin shots), stressful
(eating new foods), jeopardize social relationships (gatherings that involve food), not
seem important (older individuals?), require change in self0image.
o Theory of Reasoned Action – predicts a person’s intention to perform or not perform
an action. Attitiude determines beliefs with determine outcomes.
• Discuss definitions of health
• Demonstrate an understanding of the difference between health promotion and health
protection
• Define risk
• Discuss the relationship of risk to health and health promotion activities
• Demonstrate an understanding of stratification of risk factors by age, race and gender
• Discuss the influence of various factors on health
o Biology – genetics; some effect specific populations more than others (i.e. elderly vs
adolescents), sickle cell when both parents carry gene (most common with African,
Mediterranean, etc ancestors). Age, sex, HIV status, inherited conditions, BRCA 1-2,
family history.
o Behaviors – activity level, smoking?, substance abuse, diet. Positive changes can
reduce rates of disease.
o Social Env – social conditions of the environment in which they live. Available
resources (ed, job, wages, food, etc). social norms, attitudes, discrimination,
crime/violence. Trash? Social support/interactions, exposure to media &
technologies. Socioeconomic conditions. School quality. Public safety, etc.
o Physical Env – natural environment (plants, weather, climate), built (buildings),
housing, schools, recreation, exposure to toxic substances. Physical barriers for
those with disabilities, aesthetics (lighting, trees, benches)
o Policies and Interventions – increased tobacco taxes
o Access to quality care – healthy people 2020. How many healthcare facilites are
there? Can residents easily use them? Insurance!
• List health behaviors for health promotion and disease prevention
• Relate clinical implications of health promotion activities
• Vocabulary

o Determinants of health: biology, behaviors, social environment, physical
environment, policies and interventions, access to quality health care.
o Health promotion: any combination of health education and related organizational,
economic, and environmental supports for behavior of individuals, groups or
communities conducive to health. That which is motivated by the desire to increase
well-being and to reach the best possible health potential.
o Risk reduction: is an active process that enables individuals to react to threats. Risk
communication is the process of informing the public regarding threats and is
affected by perceptions, process, and actions.
o Health protection: consists of those activities that one undertakes to prevent
disease, detect disease in early stages, or to maximize one’s health within the
constraints of a diseased state.
o Portion distortion: refers to the growing portion size that people call “normal.”
o Modifiable risk factors: individual has control. Examples include smoking, activity,
eating habits, etc.
o Nonmodifiable risk factors: individual has little or no control. Examples include
genetics, gender, age, environmental exposure, etc.
o Risk to health & health promotion activities
• Tobacco:
o Health risk:
▪ leading cause of preventable death
▪ Most common in less educated populations and those living
below poverty level
▪ Most common form of chemical dependency
▪ Tobacco in all forms is harmful
• Health promotion activities:
▪ Ask about tobacco use
▪ Look for teachable moments
▪ Explore willingness to quit
▪ Refer to cessation programs
▪ Encourage attempts to quit
Alcohol:
• Alcohol Consumption & Health:
▪ Third leading lifestyle-related cause of death in the United
States
▪ Short-term use causes acute risks
▪ Long-term effects have major impact on health and social
issues
▪ Influenced by legal drinking age
• Health Promotion Activities:

Diet:
▪ Prevent underage drinking
▪ Assist with enforcement of legal drinking age
▪ Identify individuals and groups at risk of abuse and
dependence
▪ Educate adults and youth on dangers of alcohol
• Diet & Health
▪ Diet- one of the most modifiable risk factors
▪ Imbalance of caloric intake and physical activity
▪ Geographic areas, age, ethnicity all influence weight
▪ Eating away from home affects “portion distortion”
▪ Special populations have different nutritional needs
▪ Individualized plans
▪ Educate clients about: balancing caloric intake and physical
activity; servings vs portion control; eating away from home
Physical activity:
• Physical activity & health:
▪ Physical activity serves both health promotion and disease
prevention purposes
▪ Leisure activities are influenced by gender, age, economic
level, geography, etc.
▪ One’s environment plays a significant role in activity level
▪ Support and develop “walkable” neighborhoods and cities
▪ Determine recommended exercise levels for individuals
Sleep:
• Sleep & Health:
▪ Sleep is an essential component of chronic disease
prevention and health promotion
▪ Requirements change with age and life circumstances
▪ Regulated by waking time and circadian rhythms
▪ Hormones during sleep affect blood pressure and kidney
function
• Heath Promotion Activities:
▪ Sleep assessment is important – identify disorders that may
affect daily activities; keep sleep log
▪ Practice sleep hygiene – establish environment that
promotes sleep; avoid activities that interfere with sleep.
Module 5: Nies Ch 6
• Discuss the major dimensions of a community
o The people (“who”)
o Location in space and time (“where” and “when”)

o Social system (“why” and “how”)
• Identify sources of information about a community's health
o Windshield survey – gain an understanding of env layout, locate possible areas of env
concern
o Analysis of demographic info – census data & reports, vital statistics, local, regional, and
state gov reports
o Needs assessment – interview key community informants, use community forums, focus
groups, or surveys.
• Describe the process of conducting a community assessment
o See above.
• Relate community assessment and aggregate diagnoses
• Identify uses for epidemiological data at each step of the nursing process
o Same for community as client
o Needs assessment
o Diagnosing health problems
o Planning
o Intervention
o Evaluation
• Community Health Dx –
o Increased risk of (disability, disease, etc) among (community or population) r/t
(etiological statement) as demonstrated in (health indicators).
• Vocabulary
o Aggregate: the “who.” Group of people who share a common aspect (age, economic
status, cultural background, gender, area of residence, or chronic illness). Subgroups or
subpopulations that have some common characteristics or concerns.
o Census tracts: a geographic region defined for the purpose of taking a census. The
census provides demographic information including age, sex, race and ethnicity,
education, SES, and housing characteristics of each member of a census tract.
o Vital statistics: the official registration records of births, deaths, marriages, divorces, and
adoptions. These events are collected and reported annually by city, county, and state
health departments.
o Windshield survey: helps to gain an understanding of environmental layout. Allows one
to locate possible areas of environmental concern. 6 categories include: community
vitality, indicators of social and economic conditions, health resources, environmental
conditions related to health, social functioning, and attitudes toward health and health
care.
o Healthy communities: “Healthy Cities and Health Communities” is a movement to help
community members bring about positive health changes. Interconnectedness between
public and private sectors is essential to make changes. Each community has its own
unique perspective.
o Focus group: a group interview involving a small number of demographically similar
people. Very effective in gathering community views, particularly for remote and
vulnerable segments of a community and for those with underdeveloped opinions.
o Evaluation process: questionnaires, feedback, compilation of incidence data for long-
term evaluation
o Key informants: knowledgeable residents, elected officials, or health care providers.

o Nature of community: aggregate of people, location in space and time, and social
system.
o Assessing the community – sources of data: census tracts, vital statistics, local, regional,
and state government reports.
Module 6: Nies Ch 33
• Differentiate between spirituality and religion
o Spirituality – human desire for a sense of meaning, purpose, connection, and fulfillment
through intimate relationships and life experiences.
• Understand the potential role of faith communities in improving the health of Americans
o Provide care for the indigent and disenfranchised, meeting basic needs/basic healthcare.
o Many religions have traditions/rituals related to health/healing.
o Some give guidelines for ministering to ill, homebound, or dying.
o Old testament discusses shalom or god’s desire for health/wholeness.
o New testament documents healing of Jesus, restoring health to people.
o Contribute to the well-being of their members through support, prayer, hope. (human
need of belonging).
• Describe the philosophy and historical basis of faith community nursing
o Rev. Granger Westberg (Lutheran)
o Partnership between hospital/church congregations
o 1984: first parish nurse program at Lutheran General in Chicago
o FCN now practice in more than 23 countries, identify selves in a manner most accepted
by faith communities.
• Define the roles, functions and education of the faith community nurse
o Integration of practice of faith/practice of nursing.
o Roles –
▪ Health educator
▪ Personal health counselor
▪ Referral agent
▪ Health advocate
▪ Coordinator of volunteers
▪ Developer of support groups
▪ Integrator of health/healing.
o Education –
▪ Role of church in healthcare
▪ History/philosophy of FCN
▪ Models of FCN
▪ Roles/functions of FCN
▪ Community assessment/resources
▪ Health promotion across lifespan
▪ Philosophy of self care
▪ Ministerial team/nursing role
▪ Legal/ethical issues
▪ FCN’s role in worship, prayer, healing.
▪ Starting a FCN program.

• Discuss faith communities as clients of the community health nurse
• Describe the role of the faith community nurse in the spiritual health and wellness of faith
communities
o Spiritual dimension is central to practice
o Balance the science/tech of nursing with service/spiritual care.
o Built upon principles of self care and a focus on understanding the connection between
health/relationship with god, faith traditions, broader society.
o Holistic health – req connection between spiritual, psychological, physical, social
dimensions.
• Discuss contemporary issues in faith community nursing, such as working with vulnerable
populations and facing ethical and legal issues
o Providing care to vulnerable populations – goal? Improve health of diverse groups and
populations using skills, assessment, planning, interventions.
o End of life issues: grief/loss – help support patient and family through this process
o Family violence prevention – (Healthy People 2020) education/prevention is essential
info. Must understand risk factors for abuse, knowledge of cycle of abuse, assessment
skills. Effects every group and population.
o Confidentiality – same standards as other nurses. SBoN, employment agencies, HIPAA
may not apply to institution that isn’t healthcare, so this can be sticky.
o Accountability – non-ordained ministers. Do not have client professional standards.
Document!!!!!
• Vocabulary
o CIRCLE MODEL
o Caring
o Intuition
o Respect for religious beliefs/practices
o Caution
o Listening
o Emotional support
o Integrator of Health and Healing: acknowledges and integrates spirituality as the basis of
nursing practice. May lead or contribute to healing services as a member of the health
ministry. Understands that spirituality is the foundation of parish nurse practice.
o Health Educator: the parish nurse provides or coordinates educational offerings for people of
all ages and developmental stages. The educational efforts may target lifestyle, values and
wellness and they also incorporate the spiritual aspects of well-being to the individual and
community.
o Personal Health Counselor: the parish nurse discusses health problems with individuals and
families within the church community. The nurse may focus on self-care issues such as
explaining a prescribed medical regimen, assessing the need for further resources and
referrals, or making home visits to homes, nursing homes, or hospitals.
o Health Advocate: the parish nurse facilitates client’s efforts in obtaining needed health
services and appropriate care management plans. The nurse promotes community awareness
of significant health problems, lobbies for beneficial public policy, and stimulates supportive
action for health.
o Coordinator of Volunteers: this role includes recruiting, training, and directing volunteers to
work with the parish nurse program or health ministry.

o Spiritual Distress: a disruption in the life principle that pervades a person’s entire being and
that integrates and transcends one’s theological and psychosocial nature. Often the focus of
care for the faith community nurse.
o FCN & Primary, Secondary & Tertiary Prevention:
▪ Primary: assessment and teaching about parenting, health and wellness.
Development of programs and social support systems to prevent social isolation
and increase resources for successful parenting and healthy behaviors.
▪ Secondary: FCN assessment and screening to identify individuals and families at
risk. Congregational resources and educational programs developed to meet
individual and family needs.
▪ Tertiary: FCN provides, or refers, to resources for rehabilitation, for families
coping with children with disabilities or chronic health problems (parents and
children).
o Education level of FCN: baccalaureate. Prepared RN with several years’ experience in
clinical practices is best prepared for role of FCN

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