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Question 3
This is Question 1 from the unit 8:
Family Systems Therapy and Communication
For this discussion:
Consider how communication patterns can lead to symptoms
for one or more members of a family.
How might a family therapist intervene in working with
the family?
Discuss one technique or method that a family therapist
might use.
No Wikipedia
APA6
No plagiarism
Due Thursday
Chapter 1
Health: A Community View
Copyright © 2015, 2011, 2007, 2001, 1997, 1993 by Saunders,
an imprint of Elsevier Inc.
Nies: Power Points, Evolve Resources for Nies/McEwen:
Community Health Nursing, 4th ed.
1
Community/Public Health Nursing …
… is the synthesis of nursing practice and public health
practice.
… has the major goal to preserve the health of the community
and surrounding populations.
… focuses on health promotion and health maintenance.
… is associated with health and identification of populations at
risk rather than an episodic response to patient demand.
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an imprint of Elsevier Inc.
2
Nies: Power Points, Evolve Resources for Nies/McEwen:
Community Health Nursing, 4th ed.
2
The mission of public health is …
… social justice, which entitles all people to basic necessities
such as adequate income and health protection and accepts
collective burdens to make this possible.
Copyright © 2015, 2011, 2007, 2001, 1997, 1993 by Saunders,
an imprint of Elsevier Inc.
3
http://www.health.gov/phfunctions/public.htm
Nies: Power Points, Evolve Resources for Nies/McEwen:
Community Health Nursing, 4th ed.
3
How Do We Define Health?
A state of complete well-being, physical, social, and mental,
and not merely the absence of disease or infirmity.
– World Health Organization, 1958
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.
– World Health Organization, 1986
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an imprint of Elsevier Inc.
4
Nies: Power Points, Evolve Resources for Nies/McEwen:
Community Health Nursing, 4th ed.
4
Community …
… a group or collection of locality-based individuals,
interacting in social units and sharing common interests,
characteristics, values, and/or goals.
Nies and McEwen, 2013
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an imprint of Elsevier Inc.
5
Nies: Power Points, Evolve Resources for Nies/McEwen:
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5
Figure 1-2
From U.S. Department of Health and Human Services Office of
Disease Prevention and Health Promotion. Federal Interagency
Workgroup: The vision, mission, and goals of Healthy People
2020.
http://www.healthypeople.gov/2020/Consortium/HP2020Framew
ork.pdf. Accessed July 2013.
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6
Nies: Power Points, Evolve Resources for Nies/McEwen:
Community Health Nursing, 4th ed.
6
Healthy People 2020 Leading Health Indicators
Access to Health Services
Clinical Preventive Services
Environmental Quality
Injury and Violence
Maternal, Infant, and Child Health
Mental Health
Nutrition, Physical Activity, and Obesity
Oral Health
Reproductive and Sexual Health
Social Determinants
Substance Abuse
Tobacco Use
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an imprint of Elsevier Inc.
7
Nies: Power Points, Evolve Resources for Nies/McEwen:
Community Health Nursing, 4th ed.
7
Public and Community Health
Public health is the Science and Art of …
(1) preventing disease,
(2) prolonging life, and
(3) promoting health and efficiency through organized
community effort…
C.E. Winslow…
Community health extends the realm of public health …
…to include organized health efforts at the community level
through both government and private efforts.
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8
Core Public Health Functions
Assessment: Regular collection, analysis, and information
sharing about health conditions, risks, and resources in a
community.
Policy development: Use of information gathered during
assessment to develop local and state health policies and to
direct resources toward those policies.
Assurance: Focuses on the availability of necessary heath
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.
– Institute of Medicine (1988)
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Nies: Power Points, Evolve Resources for Nies/McEwen:
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10 Essential Services
Assessment
Monitor health status to identify community health problems.
Diagnose and investigate health problems and health hazards in
the community.
Research for new insights and innovative solutions to health
problems.
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Nies: Power Points, Evolve Resources for Nies/McEwen:
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10 Essential Services (Cont.)
Policy Development
Inform, educate, and empower people about health issues.
Mobilize community partnerships to identify and solve health
problems.
Develop policies and plans that support individual and
community health efforts.
Research for new insights and innovative solutions to health
problems.
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Nies: Power Points, Evolve Resources for Nies/McEwen:
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10 Essential Services (Cont.)
Assurance
Enforce laws and regulations that protect health and ensure
safety.
Link people to needed personal health services and ensure the
provision of health care when otherwise unavailable.
Ensure a competent public health and personal health care
workforce.
Evaluate effectiveness, accessibility, and quality of personal
and population-based health services.
Research for new insights and innovative solutions to health
problems.
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The Three Levels of Prevention
Primary prevention
Prevention of problems before they occur
Health promotion and health protection
Secondary prevention
Early detection and intervention
Early diagnosis and treatment
Tertiary prevention
Correction and prevention of deterioration of a disease state
Limitation of disability and rehabilitation
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Nies: Power Points, Evolve Resources for Nies/McEwen:
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The Three Levels of Prevention (Cont.)
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Figure 1-2
Nies: Power Points, Evolve Resources for Nies/McEwen:
Community Health Nursing, 4th ed.
14
Level of Prevention—Individual
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Level of Prevention—Family
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Level of Prevention—Group
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Level of Prevention—Community
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Nies: Power Points, Evolve Resources for Nies/McEwen:
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Healthy People 2020
Vision
A society in which all people live long, healthy lives.
Overarching Goals
Attain high-quality, longer lives free of preventable disease,
disability, injury, and premature death.
Achieve health equity, eliminate disparities, and improve the
health of all groups.
Create social and physical environments that promote good
health for all.
Promote quality of life, healthy development, and healthy
behaviors across all life stages.
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Healthy People 2020
(Cont.)
HP2020 has 42 focus areas
The objectives and related information and materials can help
guide health promotion activities and can be used to aid in
community-wide initiatives.
(USDHHS, 2013)
All health care practitioners…
should focus on the relevant areas in their practice
incorporate objectives into programs, events, and publications
whenever possible
use them as a framework to promote healthy cities and
communities
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Nies: Power Points, Evolve Resources for Nies/McEwen:
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Healthy People 2020 Topic Areas
Access to Quality Health Services
Adolescent Health New
Arthritis, Osteoporosis and Chronic Back Conditions
Blood Disorders and Blood Safety New
Cancer
Chronic Kidney Disease
Dementias, including Alzheimer’s Disease New
Diabetes
Disability and Secondary Conditions
Early and Middle Childhood
Educational and Community-based Programs
Environmental Health
Family Planning
Food Safety
Genomics New
Global Health New
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Nies: Power Points, Evolve Resources for Nies/McEwen:
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Healthy People 2020 Topic
Areas (Cont.)
Health Communication and Health Information Technology
Healthcare-Associated Infections New
Health-Related Quality of Life and Well-Being New
Hearing and Other Sensory or Communication Disorders
Heart Disease and Stroke
HIV
Immunization and Infectious Diseases
Injury and Violence Prevention
Lesbian, Gay, Bisexual, and Transgender
Health New
Maternal, Infant, and Child Health
Medical Product Safety
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Nies: Power Points, Evolve Resources for Nies/McEwen:
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Healthy People 2020 Topic Areas (Cont.)
Mental Health and Mental Disorders
Nutrition and Weight Status
Occupational Safety and Health
Older Health New
Oral Health
Physical Activity
Preparedness New
Public Health Infrastructure
Respiratory Disease
Sexually Transmitted Diseases
Sleep Health New
Social Determinants of Health New
Substance Abuse
Tobacco Use
Vision
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Nies: Power Points, Evolve Resources for Nies/McEwen:
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Public Health Nursing
ANA definition (2007)
The practice of promoting and protecting the health of
populations
Uses knowledge from nursing, as well as social and public
health sciences, to promote and protect the health of
populations.
Is population focused, with the goals of promoting health and
preventing disease and disability for all people
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Nies: Power Points, Evolve Resources for Nies/McEwen:
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Community Health Nursing
ANA definition (1980)
Synthesis of nursing practice and public health to promote and
preserve the health of populations
Care is directed to individuals, families, groups
Contributes to health of the total population
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*The terms Public Health Nursing and Community Health
Nursing are used interchangeably in Nies and McEwen, 6th
edition.
Community-Based Nursing
“Application of the nursing process in caring for individuals,
families and groups where they live, work or go to school or as
they move through the health care system”
–McEwen and Pullis, 2009
Setting-specific
Emphasis is on acute and chronic care
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Community and Public Health Nursing Practice
Nurses practice disease prevention and health promotion
Practice is collaborative
Practice is based on research and theory
Applies the nursing process to the care of…
Individuals
Families
Aggregates
The community
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Population-Focused Nursing
Focuses on the entire population
Is based on assessment of the population’s health status
Considers the broad determinants of health
Emphasizes all levels of prevention
Intervenes with communities, systems, individuals, and families
– Minnesota Department of Health, 2003
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PHN Intervention Wheel
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Figure 1-3
Illustration from Minnesota Dept. of Health Center for Public
Health Nursing.
Is population based
Contains three levels of practice (individual, community, and
system)
Identifies 17 public health interventions
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Community Health Nursing, 4th ed.
29
Public Health Interventions
(purple section)
Surveillance: Describes and monitors health events through
ongoing and systematic collection, analysis, and interpretation
of health data for the purpose of planning, implementing, and
evaluating public health interventions.
Disease and other health event investigation: Systematically
gathers and analyzes data regarding threats to the health of
populations, ascertains the source of the threat, identifies cases
and others at risk, and determines control measures.
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Public Health Interventions
(purple section) (Cont.)
Outreach: Locates populations of interest or populations at risk
and provides information about the nature of the concern, what
can be done about it, and how services can be obtained.
Screening: Identifies individuals with unrecognized health risk
factors or asymptomatic disease conditions in populations.
Case finding: Locates individuals and families with identified
risk factors and connects them with resources.
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Public Health Interventions
(green section)
Referral and follow-up: Helps individuals, families, groups,
organizations, and/or communities identify and access necessary
resources to prevent or resolve problems or concerns.
Case management: Optimizes self-care capabilities of
individuals and families and the capacity of systems and
communities to coordinate and provide services.
Delegated functions: Direct care tasks a registered professional
nurse carries out under the authority of a health care
practitioner as allowed by law.
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Public Health Interventions
(blue section)
Health teaching: Communicates facts, ideas, and skills that
change knowledge, attitudes, values, beliefs, behaviors, and
practices of individuals, families, systems, and/or communities.
Counseling: Establishes an interpersonal relationship intended
to increase or enhance capacity for self-care and coping with a
community, system, and family or individual.
Consultation: Seeks information and generates optional
solutions to perceived problems or issues through interactive
problem-solving with a community, system, and family or
individual.
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Public Health Interventions
(red section)
Collaboration: Commits two or more persons or organizations to
achieve a common goal through enhancing the capacity of one
or more of the members to promote and protect health.
Coalition building: Promotes and develops alliances among
organizations or constituencies for a common purpose.
Community organizing: Helps community groups identify
common problems or goals, mobilize resources, and develop and
implement strategies for reaching the goals they collectively
have set.
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Public Health Interventions
(yellow section)
Advocacy: Plead someone’s cause or act on someone’s behalf,
with focus on developing the capacity of the community,
system, and individual or family to plead their own cause or act
on their own behalf.
Social marketing: Uses commercial marketing principles and
technologies for programs designed to influence the knowledge,
attitudes, values, beliefs, behaviors, and practices of the
population of interest.
Policy development and enforcement: Places health issues on
decision-makers’ agendas, acquires a plan of resolution, and
determines needed resources, resulting in laws, rules,
regulations, ordinances, and policies. Policy enforcement
compels others to comply with laws, rules, regulations,
ordinances, and policies.
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Providing population-based care… a shift in thinking
Populations are not homogeneous; must address the needs of
special subpopulations.
High-risk and vulnerable subpopulations must be identified
early in the care delivery cycle.
Nonusers of services often become high-cost users; essential to
develop outreach strategies.
Quality and cost of all health care services are linked together
across the health care continuum.
(Kaiser Family Foundation, 2013)
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36
Chapter 2
Historical Factors:
Community Health Nursing in Context
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an imprint of Elsevier Inc.
Stages* in the Disease History of Humankind
Hunting and gathering (before 10,000 B.C.)
Settled villages (10,000 to 6000 B.C.)
Preindustrial cities (6000 B.C. to 1800 A.D.)
Industrial cities (1700 to 1800 A.D.)
Present period (1900 to 2000 A.D.)
*Stages overlap and time periods are widely debated in the field
of anthropology. Some form of each stage remains evident in
the world today.
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Aggregate Impact on Health
Increased population
Increased population density
Imbalanced human ecology
Resulted in changes in cultural adaptation
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Evolution of Early Public Health Efforts
Prerecorded historic times (before 5000 B.C.)
Practices based on superstition or sanitation
Health practices evolved to ensure survival
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Evolution of Early Public Health Efforts (Cont.)
Classical times (3000 to 200 B.C.)
Devised ways to flush water; constructed drainage systems
Developed pharmaceutical preparations
Embalmed the dead
Dealt with pollution
Hygienic code to protect food and water
Greek and Roman impact public health
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Evolution of Early Public Health Efforts (Cont.)
Greeks
Literature contains accounts of communicable diseases
Endemic, epidemic, and pandemic
Hippocratic book on Airs, Waters and Places
Hygeia, goddess of health, or good living
Panacea, goddess of curative medicine
Balance of human life with environmental demands
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Disease Definitions
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7DiseaseDefinitionsEndemicDiseases that are always present in
a population (e.g., colds and pneumonia).EpidemicDiseases that
are not always present in a population but flare up on occasion
(e.g., diphtheria and measles).PandemicThe existence of disease
in a large proportion of the population—a global epidemic (e.g.,
HIV, AIDS, and annual outbreaks of influenza type A).
Evolution of Early Public Health Efforts (Cont.)
Romans
Surpassed Greek engineering
Massive aqueducts, bathhouses, and sewer systems
Addressed occupational health threats
Priests mediated diseases and dispensed medicine
Public physicians worked in designated towns
Worked in groups much like today’s HMOs
Eared money to care for the poor
Hospital for sick poor established by Fabiola, a Christian
woman
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Evolution of Early Public Health Efforts (Cont.)
Middle Ages (500 to 1500 A.D.)
Monasteries promoted collective activity to protect public
health.
Churches enforced hygienic codes.
A pandemic ravaged the world in the 14th century.
Modern public health practices (e.g., isolation, disinfection,
quarantines) emerged.
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Evolution of Early Public Health Efforts (Cont.)
Renaissance (15th, 16th, 17th centuries)
A theory about the cause of infection evolved.
Leeuwenhoek described microscopic organisms.
Elizabethan Poor Laws were enacted.
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Evolution of Early Public Health Efforts (Cont.)
18th century
The Industrial Revolution occurred.
Poor children were forced into labor.
Vaccination was discovered by Edward Jenner.
Sanitary Revolution’s public health
reforms were taking place.
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Evolution of Early Public Health Efforts (Cont.)
19th century
Communicable diseases ravaged the population that lived in
unsanitary conditions.
Edwin Chadwick examined death rates by occupation and class
in England.
The General Board of Health for England was established in
1848.
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Evolution of Early Public Health Efforts (Cont.)
19th century (Cont.)
Public health laws were enacted in 1849:
Healthy mental and physical development of citizens
Prevention of all dangers to health
Control of disease
John Snow demonstrated the transmission
of cholera via the public water source.
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Evolution of Early Public Health Efforts (Cont.)
19th century (Cont.)
Waves of epidemics occurred in the United States.
Lemuel Shattuck published vital statistics in Massachusetts; he
called for child health reform.
The first Board of Health was formed in response.
The AMA was asked to collected vital statistics.
Efforts focused on determinants of health.
The advent of “modern” health care occurred.
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Florence Nightingale (1820-1910)
Credited with establishing “modern nursing”
Concern for environmental determinants of health
Emphasis on sanitation, community assessment, and analysis
Use of graphically depicted statistics and comparable census
data
Political advocate
Education reform for nurses
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Figure 2-2
Public domain; courtesy University of Chicago Library.
Impact of Important Scientists
Louis Pasteur
Theory of existence of germs
Discovered immunizations in 1881 and the rabies vaccine in
1885
Robert Koch
Discovered causative agent for cholera and the tubercle bacillus
in 1882
Joseph Lister
Surgical success with wound care
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“Modern” Medical Care
Emergence of germ theory focused diagnosis and treatment on
individual organism and individual disease.
Community outcry for social reforms forced governments to
take action.
Boards of health and health departments began in 1866.
TB surveillance began in 1889.
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“Modern” Medical Care (Cont.)
Flexner Report (1910) outlined shortcomings of U.S. medical
schools.
Philanthropic foundations influenced health care efforts.
1916: Rockefeller Foundation
established first school of
public health at Johns Hopkins.
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Community Caregiver
Traditional healer common in non-Western, ancient, and
primitive societies.
Societies retain folk practices because of their success.
Folk healing practices are socially cohesive and involve support
systems.
Although often overlooked, cultural
practices affect health.
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Establishment of Public Health Nursing
In England
District Nursing in England, 1850s
Rathbone worked with Nightingale to educate “health nurses,”
1859
Health Visiting in Manchester, England, 1862
In the United States
Visiting Nurses, 1877
Henry Street Settlement, 1893
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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 United States—later called “Visiting Nurses Association of
NYC”
Role of Henry Street Settlement was “one of helping people to
help themselves” (Wald, 1871)
The Children’s Bureau and the
Social Security Act Legislation
formed as a result of these efforts
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Other Key Dates in the Establishment of PH Nursing
First School Nurse, Linda Rogers, 1902
Metropolitan Life Insurance Company provided home nurses for
policyholders, 1909
Department of Nursing and Health at Teachers’ College of
Columbia University in NYC, 1910
National Organization of Public Health Nurses formed, 1912
(Lillian Wald was first president)
Public Health Service appointed its first public health nurse,
1913
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Changing Perspectives on Mortality in the 20th Century and
Beyond
Change from infectious diseases to chronic conditions
Modern medical advances (vaccination programs and
antibiotics)
Holistic approach to health
Better sanitation and nutrition
Grecian Hygeia (i.e., healthful living) vs. Panacea (i.e., cure)
dichotomy
Multi-causal, not uni-causal,
view of disease
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Challenges for Community Health Nursing
Promote the health of populations
Need a broadened focus on the multiple causes of morbidity and
mortality
Aware of increased technological advances
Understand the community need for a focus on prevention,
health promotion, and home care
Focus on holistic care
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Challenges for Community Health Nursing (Cont.)
Emphasis on population-based focus nursing
Work on behalf of aggregates
Understand social determinants of health
Gather information and statistics to make decisions
Be part of the solution to find ways to solve persistent health
problems
Emphasize society’s responsibility for health
Empower people to help themselves
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25
Chapter 6
Community Assessment
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an imprint of Elsevier Inc.
Defining the Community
Aggregate of people
The “who”
Share personal characteristics and risks
Location in space and time
The “where” and “when”
Physical location frequently delineated by boundaries and
influenced by the passage of time
Social system
The “why” and “how”
Interrelationships of aggregates fulfilling community functions
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Diagram of Assessment Parameters
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3
Figure 6-1
Community Assessment Parameters
Geography
Population
Environment
Industry
Education
Recreations
Religion
Communication
Transportation
Copyright © 2015, 2011, 2007, 2001, 1997, 1993 by Saunders,
an imprint of Elsevier Inc.
4
Public services
Political organization
Community development or planning
Disaster programs
Health statistics
Social problems
Health manpower
Health professional organizations
Community services
Healthy Communities
A movement to help community members bring about positive
health changes
Interconnectedness between people and the public and private
sectors is essential to make changes.
Each community has its unique perspective.
Copyright © 2015, 2011, 2007, 2001, 1997, 1993 by Saunders,
an imprint of Elsevier Inc.
5
Assessing the Community
Windshield survey
Gain an understanding of environmental layout
Locate possible areas of environmental concern through “sight,
sense, and sound”
Gives nurse an opportunity to observe people and their role in
the community
Copyright © 2015, 2011, 2007, 2001, 1997, 1993 by Saunders,
an imprint of Elsevier Inc.
6
Windshield Survey
Community vitality
Indicators of social and economic conditions
Health resources
Copyright © 2015, 2011, 2007, 2001, 1997, 1993 by Saunders,
an imprint of Elsevier Inc.
7
Environmental conditions related to health
Social functioning
Attitudes toward health and health care
Assessing the Community (Cont.)
Sources of data:
Census data and other census reports
Vital statistics
NCHS survey data
Local, regional, and state government reports
Locally generated data collection
Analysis of demographic information provides descriptive
information about the population
Copyright © 2015, 2011, 2007, 2001, 1997, 1993 by Saunders,
an imprint of Elsevier Inc.
8
Assessing the Community (Cont.)
Needs assessment
Used to understand the community’s perspective
Interview key community informants
Use community forums, focus groups, or surveys
12 Steps in a Needs Assessment
Copyright © 2015, 2011, 2007, 2001, 1997, 1993 by Saunders,
an imprint of Elsevier Inc.
9
Steps in the Needs Assessment Process
Identify aggregate for assessment
Engage the community in planning the assessment
Identify required information
Select method of data gathering
Develop questionnaires or interview questions
Develop procedures for data collection
Copyright © 2015, 2011, 2007, 2001, 1997, 1993 by Saunders,
an imprint of Elsevier Inc.
10
Steps in the Needs Assessment Process (Cont.)
Train data collectors
Arrange for a sample representative of the aggregate
Conduct needs assessment
Tabulate and analyze data
Identify needs suggested by data
Develop an action plan
Copyright © 2015, 2011, 2007, 2001, 1997, 1993 by Saunders,
an imprint of Elsevier Inc.
11
Nursing Process
Copyright © 2015, 2011, 2007, 2001, 1997, 1993 by Saunders,
an imprint of Elsevier Inc.
12
The nursing process can be applied to the community as a
client.
Needs assessment
Diagnosing health problems (actual and potential)
Planning
Intervention
Evaluation
Format for Community Health Diagnosis
Copyright © 2015, 2011, 2007, 2001, 1997, 1993 by Saunders,
an imprint of Elsevier Inc.
13
Figure 6-3 Redrawn from Muecke MA: Community health
diagnosis in nursing, Public Health Nurs 1:23-35, 1984. Used
with permission of Blackwell Scientific Publications.
Epidemiological Studies Used Throughout the Nursing Process
Support planning by establishing effectiveness of certain
interventions in specific aggregates
Construct benchmarks to gauge achievement of program
objectives
Compare data with other rates
Identify objectives of successful programs
Document effectiveness with epidemiological data
Copyright © 2015, 2011, 2007, 2001, 1997, 1993 by Saunders,
an imprint of Elsevier Inc.
14

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Question 3This is Question 1 from the unit 8Family Systems Th.docx

  • 1. Question 3 This is Question 1 from the unit 8: Family Systems Therapy and Communication For this discussion: Consider how communication patterns can lead to symptoms for one or more members of a family. How might a family therapist intervene in working with the family? Discuss one technique or method that a family therapist might use. No Wikipedia APA6 No plagiarism Due Thursday Chapter 1 Health: A Community View Copyright © 2015, 2011, 2007, 2001, 1997, 1993 by Saunders, an imprint of Elsevier Inc. Nies: Power Points, Evolve Resources for Nies/McEwen: Community Health Nursing, 4th ed. 1 Community/Public Health Nursing … … is the synthesis of nursing practice and public health practice.
  • 2. … has the major goal to preserve the health of the community and surrounding populations. … focuses on health promotion and health maintenance. … is associated with health and identification of populations at risk rather than an episodic response to patient demand. Copyright © 2015, 2011, 2007, 2001, 1997, 1993 by Saunders, an imprint of Elsevier Inc. 2 Nies: Power Points, Evolve Resources for Nies/McEwen: Community Health Nursing, 4th ed. 2 The mission of public health is … … social justice, which entitles all people to basic necessities such as adequate income and health protection and accepts collective burdens to make this possible. Copyright © 2015, 2011, 2007, 2001, 1997, 1993 by Saunders, an imprint of Elsevier Inc. 3 http://www.health.gov/phfunctions/public.htm Nies: Power Points, Evolve Resources for Nies/McEwen: Community Health Nursing, 4th ed. 3 How Do We Define Health? A state of complete well-being, physical, social, and mental, and not merely the absence of disease or infirmity. – World Health Organization, 1958 The extent to which an individual or group is able, on the one
  • 3. 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. – World Health Organization, 1986 Copyright © 2015, 2011, 2007, 2001, 1997, 1993 by Saunders, an imprint of Elsevier Inc. 4 Nies: Power Points, Evolve Resources for Nies/McEwen: Community Health Nursing, 4th ed. 4 Community … … a group or collection of locality-based individuals, interacting in social units and sharing common interests, characteristics, values, and/or goals. Nies and McEwen, 2013 Copyright © 2015, 2011, 2007, 2001, 1997, 1993 by Saunders, an imprint of Elsevier Inc. 5 Nies: Power Points, Evolve Resources for Nies/McEwen: Community Health Nursing, 4th ed. 5 Figure 1-2 From U.S. Department of Health and Human Services Office of
  • 4. Disease Prevention and Health Promotion. Federal Interagency Workgroup: The vision, mission, and goals of Healthy People 2020. http://www.healthypeople.gov/2020/Consortium/HP2020Framew ork.pdf. Accessed July 2013. Copyright © 2015, 2011, 2007, 2001, 1997, 1993 by Saunders, an imprint of Elsevier Inc. 6 Nies: Power Points, Evolve Resources for Nies/McEwen: Community Health Nursing, 4th ed. 6 Healthy People 2020 Leading Health Indicators Access to Health Services Clinical Preventive Services Environmental Quality Injury and Violence Maternal, Infant, and Child Health Mental Health Nutrition, Physical Activity, and Obesity Oral Health Reproductive and Sexual Health Social Determinants Substance Abuse Tobacco Use Copyright © 2015, 2011, 2007, 2001, 1997, 1993 by Saunders, an imprint of Elsevier Inc. 7 Nies: Power Points, Evolve Resources for Nies/McEwen: Community Health Nursing, 4th ed.
  • 5. 7 Public and Community Health Public health is the Science and Art of … (1) preventing disease, (2) prolonging life, and (3) promoting health and efficiency through organized community effort… C.E. Winslow… Community health extends the realm of public health … …to include organized health efforts at the community level through both government and private efforts. Copyright © 2015, 2011, 2007, 2001, 1997, 1993 by Saunders, an imprint of Elsevier Inc. 8 Core Public Health Functions Assessment: Regular collection, analysis, and information sharing about health conditions, risks, and resources in a community. Policy development: Use of information gathered during assessment to develop local and state health policies and to direct resources toward those policies. Assurance: Focuses on the availability of necessary heath 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. – Institute of Medicine (1988) Copyright © 2015, 2011, 2007, 2001, 1997, 1993 by Saunders, an imprint of Elsevier Inc. 9
  • 6. Nies: Power Points, Evolve Resources for Nies/McEwen: Community Health Nursing, 4th ed. 9 10 Essential Services Assessment Monitor health status to identify community health problems. Diagnose and investigate health problems and health hazards in the community. Research for new insights and innovative solutions to health problems. Copyright © 2015, 2011, 2007, 2001, 1997, 1993 by Saunders, an imprint of Elsevier Inc. 10 Nies: Power Points, Evolve Resources for Nies/McEwen: Community Health Nursing, 4th ed. 10 10 Essential Services (Cont.) Policy Development Inform, educate, and empower people about health issues. Mobilize community partnerships to identify and solve health problems. Develop policies and plans that support individual and community health efforts. Research for new insights and innovative solutions to health problems. Copyright © 2015, 2011, 2007, 2001, 1997, 1993 by Saunders, an imprint of Elsevier Inc. 11
  • 7. Nies: Power Points, Evolve Resources for Nies/McEwen: Community Health Nursing, 4th ed. 11 10 Essential Services (Cont.) Assurance Enforce laws and regulations that protect health and ensure safety. Link people to needed personal health services and ensure the provision of health care when otherwise unavailable. Ensure a competent public health and personal health care workforce. Evaluate effectiveness, accessibility, and quality of personal and population-based health services. Research for new insights and innovative solutions to health problems. Copyright © 2015, 2011, 2007, 2001, 1997, 1993 by Saunders, an imprint of Elsevier Inc. 12 Nies: Power Points, Evolve Resources for Nies/McEwen: Community Health Nursing, 4th ed. 12 The Three Levels of Prevention Primary prevention Prevention of problems before they occur Health promotion and health protection Secondary prevention Early detection and intervention Early diagnosis and treatment Tertiary prevention Correction and prevention of deterioration of a disease state
  • 8. Limitation of disability and rehabilitation Copyright © 2015, 2011, 2007, 2001, 1997, 1993 by Saunders, an imprint of Elsevier Inc. 13 Nies: Power Points, Evolve Resources for Nies/McEwen: Community Health Nursing, 4th ed. 13 The Three Levels of Prevention (Cont.) Copyright © 2015, 2011, 2007, 2001, 1997, 1993 by Saunders, an imprint of Elsevier Inc. 14 Figure 1-2 Nies: Power Points, Evolve Resources for Nies/McEwen: Community Health Nursing, 4th ed. 14 Level of Prevention—Individual Copyright © 2015, 2011, 2007, 2001, 1997, 1993 by Saunders, an imprint of Elsevier Inc. 15 Nies: Power Points, Evolve Resources for Nies/McEwen: Community Health Nursing, 4th ed. 15
  • 9. Level of Prevention—Family Copyright © 2015, 2011, 2007, 2001, 1997, 1993 by Saunders, an imprint of Elsevier Inc. 16 Nies: Power Points, Evolve Resources for Nies/McEwen: Community Health Nursing, 4th ed. 16 Level of Prevention—Group Copyright © 2015, 2011, 2007, 2001, 1997, 1993 by Saunders, an imprint of Elsevier Inc. 17 Nies: Power Points, Evolve Resources for Nies/McEwen: Community Health Nursing, 4th ed. 17 Level of Prevention—Community Copyright © 2015, 2011, 2007, 2001, 1997, 1993 by Saunders, an imprint of Elsevier Inc. 18 Nies: Power Points, Evolve Resources for Nies/McEwen: Community Health Nursing, 4th ed. 18
  • 10. Healthy People 2020 Vision A society in which all people live long, healthy lives. Overarching Goals Attain high-quality, longer lives free of preventable disease, disability, injury, and premature death. Achieve health equity, eliminate disparities, and improve the health of all groups. Create social and physical environments that promote good health for all. Promote quality of life, healthy development, and healthy behaviors across all life stages. Copyright © 2015, 2011, 2007, 2001, 1997, 1993 by Saunders, an imprint of Elsevier Inc. 19 Nies: Power Points, Evolve Resources for Nies/McEwen: Community Health Nursing, 4th ed. 19 Healthy People 2020 (Cont.) HP2020 has 42 focus areas The objectives and related information and materials can help guide health promotion activities and can be used to aid in community-wide initiatives. (USDHHS, 2013) All health care practitioners… should focus on the relevant areas in their practice incorporate objectives into programs, events, and publications whenever possible use them as a framework to promote healthy cities and
  • 11. communities Copyright © 2015, 2011, 2007, 2001, 1997, 1993 by Saunders, an imprint of Elsevier Inc. 20 Nies: Power Points, Evolve Resources for Nies/McEwen: Community Health Nursing, 4th ed. 20 Healthy People 2020 Topic Areas Access to Quality Health Services Adolescent Health New Arthritis, Osteoporosis and Chronic Back Conditions Blood Disorders and Blood Safety New Cancer Chronic Kidney Disease Dementias, including Alzheimer’s Disease New Diabetes Disability and Secondary Conditions Early and Middle Childhood Educational and Community-based Programs Environmental Health Family Planning Food Safety Genomics New Global Health New Copyright © 2015, 2011, 2007, 2001, 1997, 1993 by Saunders, an imprint of Elsevier Inc. 21 Nies: Power Points, Evolve Resources for Nies/McEwen:
  • 12. Community Health Nursing, 4th ed. 21 Healthy People 2020 Topic Areas (Cont.) Health Communication and Health Information Technology Healthcare-Associated Infections New Health-Related Quality of Life and Well-Being New Hearing and Other Sensory or Communication Disorders Heart Disease and Stroke HIV Immunization and Infectious Diseases Injury and Violence Prevention Lesbian, Gay, Bisexual, and Transgender Health New Maternal, Infant, and Child Health Medical Product Safety Copyright © 2015, 2011, 2007, 2001, 1997, 1993 by Saunders, an imprint of Elsevier Inc. 22 Nies: Power Points, Evolve Resources for Nies/McEwen: Community Health Nursing, 4th ed. 22 Healthy People 2020 Topic Areas (Cont.) Mental Health and Mental Disorders Nutrition and Weight Status Occupational Safety and Health Older Health New Oral Health Physical Activity
  • 13. Preparedness New Public Health Infrastructure Respiratory Disease Sexually Transmitted Diseases Sleep Health New Social Determinants of Health New Substance Abuse Tobacco Use Vision Copyright © 2015, 2011, 2007, 2001, 1997, 1993 by Saunders, an imprint of Elsevier Inc. 23 Nies: Power Points, Evolve Resources for Nies/McEwen: Community Health Nursing, 4th ed. 23 Public Health Nursing ANA definition (2007) The practice of promoting and protecting the health of populations Uses knowledge from nursing, as well as social and public health sciences, to promote and protect the health of populations. Is population focused, with the goals of promoting health and preventing disease and disability for all people Copyright © 2015, 2011, 2007, 2001, 1997, 1993 by Saunders, an imprint of Elsevier Inc. 24 Nies: Power Points, Evolve Resources for Nies/McEwen: Community Health Nursing, 4th ed.
  • 14. 24 Community Health Nursing ANA definition (1980) Synthesis of nursing practice and public health to promote and preserve the health of populations Care is directed to individuals, families, groups Contributes to health of the total population Copyright © 2015, 2011, 2007, 2001, 1997, 1993 by Saunders, an imprint of Elsevier Inc. 25 *The terms Public Health Nursing and Community Health Nursing are used interchangeably in Nies and McEwen, 6th edition. Community-Based Nursing “Application of the nursing process in caring for individuals, families and groups where they live, work or go to school or as they move through the health care system” –McEwen and Pullis, 2009 Setting-specific Emphasis is on acute and chronic care Copyright © 2015, 2011, 2007, 2001, 1997, 1993 by Saunders, an imprint of Elsevier Inc. 26 Community and Public Health Nursing Practice Nurses practice disease prevention and health promotion Practice is collaborative Practice is based on research and theory
  • 15. Applies the nursing process to the care of… Individuals Families Aggregates The community Copyright © 2015, 2011, 2007, 2001, 1997, 1993 by Saunders, an imprint of Elsevier Inc. 27 Population-Focused Nursing Focuses on the entire population Is based on assessment of the population’s health status Considers the broad determinants of health Emphasizes all levels of prevention Intervenes with communities, systems, individuals, and families – Minnesota Department of Health, 2003 Copyright © 2015, 2011, 2007, 2001, 1997, 1993 by Saunders, an imprint of Elsevier Inc. 28 Nies: Power Points, Evolve Resources for Nies/McEwen: Community Health Nursing, 4th ed. 28 PHN Intervention Wheel Copyright © 2015, 2011, 2007, 2001, 1997, 1993 by Saunders, an imprint of Elsevier Inc. 29 Figure 1-3 Illustration from Minnesota Dept. of Health Center for Public Health Nursing.
  • 16. Is population based Contains three levels of practice (individual, community, and system) Identifies 17 public health interventions Nies: Power Points, Evolve Resources for Nies/McEwen: Community Health Nursing, 4th ed. 29 Public Health Interventions (purple section) Surveillance: Describes and monitors health events through ongoing and systematic collection, analysis, and interpretation of health data for the purpose of planning, implementing, and evaluating public health interventions. Disease and other health event investigation: Systematically gathers and analyzes data regarding threats to the health of populations, ascertains the source of the threat, identifies cases and others at risk, and determines control measures. Copyright © 2015, 2011, 2007, 2001, 1997, 1993 by Saunders, an imprint of Elsevier Inc. 30 Nies: Power Points, Evolve Resources for Nies/McEwen: Community Health Nursing, 4th ed. 30 Public Health Interventions (purple section) (Cont.) Outreach: Locates populations of interest or populations at risk
  • 17. and provides information about the nature of the concern, what can be done about it, and how services can be obtained. Screening: Identifies individuals with unrecognized health risk factors or asymptomatic disease conditions in populations. Case finding: Locates individuals and families with identified risk factors and connects them with resources. Copyright © 2015, 2011, 2007, 2001, 1997, 1993 by Saunders, an imprint of Elsevier Inc. 31 Nies: Power Points, Evolve Resources for Nies/McEwen: Community Health Nursing, 4th ed. 31 Public Health Interventions (green section) Referral and follow-up: Helps individuals, families, groups, organizations, and/or communities identify and access necessary resources to prevent or resolve problems or concerns. Case management: Optimizes self-care capabilities of individuals and families and the capacity of systems and communities to coordinate and provide services. Delegated functions: Direct care tasks a registered professional nurse carries out under the authority of a health care practitioner as allowed by law. Copyright © 2015, 2011, 2007, 2001, 1997, 1993 by Saunders, an imprint of Elsevier Inc. 32 Nies: Power Points, Evolve Resources for Nies/McEwen: Community Health Nursing, 4th ed.
  • 18. 32 Public Health Interventions (blue section) Health teaching: Communicates facts, ideas, and skills that change knowledge, attitudes, values, beliefs, behaviors, and practices of individuals, families, systems, and/or communities. Counseling: Establishes an interpersonal relationship intended to increase or enhance capacity for self-care and coping with a community, system, and family or individual. Consultation: Seeks information and generates optional solutions to perceived problems or issues through interactive problem-solving with a community, system, and family or individual. Copyright © 2015, 2011, 2007, 2001, 1997, 1993 by Saunders, an imprint of Elsevier Inc. 33 Nies: Power Points, Evolve Resources for Nies/McEwen: Community Health Nursing, 4th ed. 33 Public Health Interventions (red section) Collaboration: Commits two or more persons or organizations to achieve a common goal through enhancing the capacity of one or more of the members to promote and protect health. Coalition building: Promotes and develops alliances among organizations or constituencies for a common purpose. Community organizing: Helps community groups identify common problems or goals, mobilize resources, and develop and implement strategies for reaching the goals they collectively
  • 19. have set. Copyright © 2015, 2011, 2007, 2001, 1997, 1993 by Saunders, an imprint of Elsevier Inc. 34 Nies: Power Points, Evolve Resources for Nies/McEwen: Community Health Nursing, 4th ed. 34 Public Health Interventions (yellow section) Advocacy: Plead someone’s cause or act on someone’s behalf, with focus on developing the capacity of the community, system, and individual or family to plead their own cause or act on their own behalf. Social marketing: Uses commercial marketing principles and technologies for programs designed to influence the knowledge, attitudes, values, beliefs, behaviors, and practices of the population of interest. Policy development and enforcement: Places health issues on decision-makers’ agendas, acquires a plan of resolution, and determines needed resources, resulting in laws, rules, regulations, ordinances, and policies. Policy enforcement compels others to comply with laws, rules, regulations, ordinances, and policies. Copyright © 2015, 2011, 2007, 2001, 1997, 1993 by Saunders, an imprint of Elsevier Inc. 35 Nies: Power Points, Evolve Resources for Nies/McEwen: Community Health Nursing, 4th ed.
  • 20. 35 Providing population-based care… a shift in thinking Populations are not homogeneous; must address the needs of special subpopulations. High-risk and vulnerable subpopulations must be identified early in the care delivery cycle. Nonusers of services often become high-cost users; essential to develop outreach strategies. Quality and cost of all health care services are linked together across the health care continuum. (Kaiser Family Foundation, 2013) Copyright © 2015, 2011, 2007, 2001, 1997, 1993 by Saunders, an imprint of Elsevier Inc. 36 Chapter 2 Historical Factors: Community Health Nursing in Context Copyright © 2015, 2011, 2007, 2001, 1997, 1993 by Saunders, an imprint of Elsevier Inc. Stages* in the Disease History of Humankind Hunting and gathering (before 10,000 B.C.) Settled villages (10,000 to 6000 B.C.) Preindustrial cities (6000 B.C. to 1800 A.D.) Industrial cities (1700 to 1800 A.D.) Present period (1900 to 2000 A.D.)
  • 21. *Stages overlap and time periods are widely debated in the field of anthropology. Some form of each stage remains evident in the world today. Copyright © 2015, 2011, 2007, 2001, 1997, 1993 by Saunders, an imprint of Elsevier Inc. 2 Aggregate Impact on Health Increased population Increased population density Imbalanced human ecology Resulted in changes in cultural adaptation Copyright © 2015, 2011, 2007, 2001, 1997, 1993 by Saunders, an imprint of Elsevier Inc. 3 Evolution of Early Public Health Efforts Prerecorded historic times (before 5000 B.C.) Practices based on superstition or sanitation Health practices evolved to ensure survival Copyright © 2015, 2011, 2007, 2001, 1997, 1993 by Saunders, an imprint of Elsevier Inc. 4 Evolution of Early Public Health Efforts (Cont.)
  • 22. Classical times (3000 to 200 B.C.) Devised ways to flush water; constructed drainage systems Developed pharmaceutical preparations Embalmed the dead Dealt with pollution Hygienic code to protect food and water Greek and Roman impact public health Copyright © 2015, 2011, 2007, 2001, 1997, 1993 by Saunders, an imprint of Elsevier Inc. 5 Evolution of Early Public Health Efforts (Cont.) Greeks Literature contains accounts of communicable diseases Endemic, epidemic, and pandemic Hippocratic book on Airs, Waters and Places Hygeia, goddess of health, or good living Panacea, goddess of curative medicine Balance of human life with environmental demands Copyright © 2015, 2011, 2007, 2001, 1997, 1993 by Saunders, an imprint of Elsevier Inc. 6 Disease Definitions Copyright © 2015, 2011, 2007, 2001, 1997, 1993 by Saunders, an imprint of Elsevier Inc. 7DiseaseDefinitionsEndemicDiseases that are always present in a population (e.g., colds and pneumonia).EpidemicDiseases that are not always present in a population but flare up on occasion (e.g., diphtheria and measles).PandemicThe existence of disease
  • 23. in a large proportion of the population—a global epidemic (e.g., HIV, AIDS, and annual outbreaks of influenza type A). Evolution of Early Public Health Efforts (Cont.) Romans Surpassed Greek engineering Massive aqueducts, bathhouses, and sewer systems Addressed occupational health threats Priests mediated diseases and dispensed medicine Public physicians worked in designated towns Worked in groups much like today’s HMOs Eared money to care for the poor Hospital for sick poor established by Fabiola, a Christian woman Copyright © 2015, 2011, 2007, 2001, 1997, 1993 by Saunders, an imprint of Elsevier Inc. 8 Evolution of Early Public Health Efforts (Cont.) Middle Ages (500 to 1500 A.D.) Monasteries promoted collective activity to protect public health. Churches enforced hygienic codes. A pandemic ravaged the world in the 14th century. Modern public health practices (e.g., isolation, disinfection, quarantines) emerged. Copyright © 2015, 2011, 2007, 2001, 1997, 1993 by Saunders, an imprint of Elsevier Inc. 9
  • 24. Evolution of Early Public Health Efforts (Cont.) Renaissance (15th, 16th, 17th centuries) A theory about the cause of infection evolved. Leeuwenhoek described microscopic organisms. Elizabethan Poor Laws were enacted. Copyright © 2015, 2011, 2007, 2001, 1997, 1993 by Saunders, an imprint of Elsevier Inc. 10 Evolution of Early Public Health Efforts (Cont.) 18th century The Industrial Revolution occurred. Poor children were forced into labor. Vaccination was discovered by Edward Jenner. Sanitary Revolution’s public health reforms were taking place. Copyright © 2015, 2011, 2007, 2001, 1997, 1993 by Saunders, an imprint of Elsevier Inc. 11 Evolution of Early Public Health Efforts (Cont.) 19th century Communicable diseases ravaged the population that lived in unsanitary conditions. Edwin Chadwick examined death rates by occupation and class
  • 25. in England. The General Board of Health for England was established in 1848. Copyright © 2015, 2011, 2007, 2001, 1997, 1993 by Saunders, an imprint of Elsevier Inc. 12 Evolution of Early Public Health Efforts (Cont.) 19th century (Cont.) Public health laws were enacted in 1849: Healthy mental and physical development of citizens Prevention of all dangers to health Control of disease John Snow demonstrated the transmission of cholera via the public water source. Copyright © 2015, 2011, 2007, 2001, 1997, 1993 by Saunders, an imprint of Elsevier Inc. 13 Evolution of Early Public Health Efforts (Cont.) 19th century (Cont.) Waves of epidemics occurred in the United States. Lemuel Shattuck published vital statistics in Massachusetts; he called for child health reform. The first Board of Health was formed in response. The AMA was asked to collected vital statistics. Efforts focused on determinants of health. The advent of “modern” health care occurred.
  • 26. Copyright © 2015, 2011, 2007, 2001, 1997, 1993 by Saunders, an imprint of Elsevier Inc. 14 Florence Nightingale (1820-1910) Credited with establishing “modern nursing” Concern for environmental determinants of health Emphasis on sanitation, community assessment, and analysis Use of graphically depicted statistics and comparable census data Political advocate Education reform for nurses Copyright © 2015, 2011, 2007, 2001, 1997, 1993 by Saunders, an imprint of Elsevier Inc. 15 Figure 2-2 Public domain; courtesy University of Chicago Library. Impact of Important Scientists Louis Pasteur Theory of existence of germs Discovered immunizations in 1881 and the rabies vaccine in 1885 Robert Koch Discovered causative agent for cholera and the tubercle bacillus in 1882 Joseph Lister
  • 27. Surgical success with wound care Copyright © 2015, 2011, 2007, 2001, 1997, 1993 by Saunders, an imprint of Elsevier Inc. 16 “Modern” Medical Care Emergence of germ theory focused diagnosis and treatment on individual organism and individual disease. Community outcry for social reforms forced governments to take action. Boards of health and health departments began in 1866. TB surveillance began in 1889. Copyright © 2015, 2011, 2007, 2001, 1997, 1993 by Saunders, an imprint of Elsevier Inc. 17 “Modern” Medical Care (Cont.) Flexner Report (1910) outlined shortcomings of U.S. medical schools. Philanthropic foundations influenced health care efforts. 1916: Rockefeller Foundation established first school of public health at Johns Hopkins. Copyright © 2015, 2011, 2007, 2001, 1997, 1993 by Saunders, an imprint of Elsevier Inc. 18
  • 28. Community Caregiver Traditional healer common in non-Western, ancient, and primitive societies. Societies retain folk practices because of their success. Folk healing practices are socially cohesive and involve support systems. Although often overlooked, cultural practices affect health. Copyright © 2015, 2011, 2007, 2001, 1997, 1993 by Saunders, an imprint of Elsevier Inc. 19 Establishment of Public Health Nursing In England District Nursing in England, 1850s Rathbone worked with Nightingale to educate “health nurses,” 1859 Health Visiting in Manchester, England, 1862 In the United States Visiting Nurses, 1877 Henry Street Settlement, 1893 Copyright © 2015, 2011, 2007, 2001, 1997, 1993 by Saunders, an imprint of Elsevier Inc. 20
  • 29. 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 United States—later called “Visiting Nurses Association of NYC” Role of Henry Street Settlement was “one of helping people to help themselves” (Wald, 1871) The Children’s Bureau and the Social Security Act Legislation formed as a result of these efforts Copyright © 2015, 2011, 2007, 2001, 1997, 1993 by Saunders, an imprint of Elsevier Inc. 21 Other Key Dates in the Establishment of PH Nursing First School Nurse, Linda Rogers, 1902 Metropolitan Life Insurance Company provided home nurses for policyholders, 1909 Department of Nursing and Health at Teachers’ College of Columbia University in NYC, 1910 National Organization of Public Health Nurses formed, 1912 (Lillian Wald was first president) Public Health Service appointed its first public health nurse, 1913 Copyright © 2015, 2011, 2007, 2001, 1997, 1993 by Saunders, an imprint of Elsevier Inc. 22
  • 30. Changing Perspectives on Mortality in the 20th Century and Beyond Change from infectious diseases to chronic conditions Modern medical advances (vaccination programs and antibiotics) Holistic approach to health Better sanitation and nutrition Grecian Hygeia (i.e., healthful living) vs. Panacea (i.e., cure) dichotomy Multi-causal, not uni-causal, view of disease Copyright © 2015, 2011, 2007, 2001, 1997, 1993 by Saunders, an imprint of Elsevier Inc. 23 Challenges for Community Health Nursing Promote the health of populations Need a broadened focus on the multiple causes of morbidity and mortality Aware of increased technological advances Understand the community need for a focus on prevention, health promotion, and home care Focus on holistic care Copyright © 2015, 2011, 2007, 2001, 1997, 1993 by Saunders, an imprint of Elsevier Inc. 24 Challenges for Community Health Nursing (Cont.)
  • 31. Emphasis on population-based focus nursing Work on behalf of aggregates Understand social determinants of health Gather information and statistics to make decisions Be part of the solution to find ways to solve persistent health problems Emphasize society’s responsibility for health Empower people to help themselves Copyright © 2015, 2011, 2007, 2001, 1997, 1993 by Saunders, an imprint of Elsevier Inc. 25 Chapter 6 Community Assessment Copyright © 2015, 2011, 2007, 2001, 1997, 1993 by Saunders, an imprint of Elsevier Inc. Defining the Community Aggregate of people The “who” Share personal characteristics and risks Location in space and time The “where” and “when” Physical location frequently delineated by boundaries and influenced by the passage of time Social system The “why” and “how” Interrelationships of aggregates fulfilling community functions
  • 32. Copyright © 2015, 2011, 2007, 2001, 1997, 1993 by Saunders, an imprint of Elsevier Inc. 2 Diagram of Assessment Parameters Copyright © 2015, 2011, 2007, 2001, 1997, 1993 by Saunders, an imprint of Elsevier Inc. 3 Figure 6-1 Community Assessment Parameters Geography Population Environment Industry Education Recreations Religion Communication Transportation Copyright © 2015, 2011, 2007, 2001, 1997, 1993 by Saunders, an imprint of Elsevier Inc. 4 Public services Political organization Community development or planning Disaster programs Health statistics
  • 33. Social problems Health manpower Health professional organizations Community services Healthy Communities A movement to help community members bring about positive health changes Interconnectedness between people and the public and private sectors is essential to make changes. Each community has its unique perspective. Copyright © 2015, 2011, 2007, 2001, 1997, 1993 by Saunders, an imprint of Elsevier Inc. 5 Assessing the Community Windshield survey Gain an understanding of environmental layout Locate possible areas of environmental concern through “sight, sense, and sound” Gives nurse an opportunity to observe people and their role in the community Copyright © 2015, 2011, 2007, 2001, 1997, 1993 by Saunders, an imprint of Elsevier Inc. 6
  • 34. Windshield Survey Community vitality Indicators of social and economic conditions Health resources Copyright © 2015, 2011, 2007, 2001, 1997, 1993 by Saunders, an imprint of Elsevier Inc. 7 Environmental conditions related to health Social functioning Attitudes toward health and health care Assessing the Community (Cont.) Sources of data: Census data and other census reports Vital statistics NCHS survey data Local, regional, and state government reports Locally generated data collection Analysis of demographic information provides descriptive information about the population Copyright © 2015, 2011, 2007, 2001, 1997, 1993 by Saunders, an imprint of Elsevier Inc. 8 Assessing the Community (Cont.) Needs assessment Used to understand the community’s perspective
  • 35. Interview key community informants Use community forums, focus groups, or surveys 12 Steps in a Needs Assessment Copyright © 2015, 2011, 2007, 2001, 1997, 1993 by Saunders, an imprint of Elsevier Inc. 9 Steps in the Needs Assessment Process Identify aggregate for assessment Engage the community in planning the assessment Identify required information Select method of data gathering Develop questionnaires or interview questions Develop procedures for data collection Copyright © 2015, 2011, 2007, 2001, 1997, 1993 by Saunders, an imprint of Elsevier Inc. 10 Steps in the Needs Assessment Process (Cont.) Train data collectors Arrange for a sample representative of the aggregate Conduct needs assessment Tabulate and analyze data Identify needs suggested by data Develop an action plan Copyright © 2015, 2011, 2007, 2001, 1997, 1993 by Saunders, an imprint of Elsevier Inc. 11
  • 36. Nursing Process Copyright © 2015, 2011, 2007, 2001, 1997, 1993 by Saunders, an imprint of Elsevier Inc. 12 The nursing process can be applied to the community as a client. Needs assessment Diagnosing health problems (actual and potential) Planning Intervention Evaluation Format for Community Health Diagnosis Copyright © 2015, 2011, 2007, 2001, 1997, 1993 by Saunders, an imprint of Elsevier Inc. 13 Figure 6-3 Redrawn from Muecke MA: Community health diagnosis in nursing, Public Health Nurs 1:23-35, 1984. Used with permission of Blackwell Scientific Publications. Epidemiological Studies Used Throughout the Nursing Process Support planning by establishing effectiveness of certain interventions in specific aggregates
  • 37. Construct benchmarks to gauge achievement of program objectives Compare data with other rates Identify objectives of successful programs Document effectiveness with epidemiological data Copyright © 2015, 2011, 2007, 2001, 1997, 1993 by Saunders, an imprint of Elsevier Inc. 14