Health Implications of Aggregates Social Change and Social Care Challenges for Community and Public Health Nursing Summary. Roles of the district nurse in the health care economy Best care at lower costs.
Aggregates in the Community
Social Factors Affecting Women's Health Health Promotion Strategies for Women Major Legislation Affecting Women's Health. Health and social services to promote women's health Levels of prevention and women's health.
Vulnerable Populations
Overview and History of Community Mental Health: 1960 to Present HEALTHY PEOPLE 2020: Mental Health and Mental Disorders. Mental disorders occurring in community settings Recognition and management of mental disorders Community mental health care.
Population Health Problems
Community Health Settings
Demographic trends and access issues related to occupational health care Occupational health nursing practice and professionalism. Skills and Competencies of the Occupational Health Nurse Impact of Federal Legislation on Occupational Health Legal Issues in Occupational Health.
Copyright
When using such information or methods, they should consider their own safety and that of others, including parties for whom they have a professional responsibility. It is the responsibility of physicians, relying on their own experience and knowledge of their patients, to make diagnoses, determine dosages and the best treatment for each individual patient, and to take all appropriate safety precautions.
Dedication
Author Biographies
She completed a postdoctoral research fellowship in health promotion and community health at the University of Michigan, Ann Arbor. Melanie McEwen, PhD, RN, CNE, ANEF is an associate professor at the University of Texas Health Science Center at Houston School of Nursing.
Contributors
Diane Santa Maria, MSN, RN, APHN-BC, Clinical Faculty, University of Texas School of Nursing, Houston, Texas. Summerlin, PhD, MSN, BSN, RN, CNS, assisterende professor, University of Texas Health Science Center i Houston, School of Nursing, Houston, Texas.
Reviewers
Cynthia Portman, MSN, RN, Assistant Clinical Professor in Nursing, Department of Nursing and Rehab Sciences, Angelo State University, San Angelo, Texas. Professor, Universiteit van Wisconsin - Eau Claire, Eau Claire, Wisconsin Marnie Lynn Sperling, DMD, MSN, RN, FN-CSA, assistent.
Preface
Upstream Focus
Community nursing/public health is defined as a synthesis of the practice of nursing and public health with the goals of promoting and maintaining the health of populations. The ability to prevent disease, prolong life, and promote health through organized community efforts is a component of public health.
Purpose of the Text
Students using this text will be better prepared to work with aggregates and communities in health promotion and with individuals and families in illness. Students must be prepared to work with these growing populations as part of the nursing workforce of ethnically and racially diverse people.
Major Themes Related to Promoting the Health of Populations
Contemporary theories provide frameworks for a holistic practice of community health care that helps students conceptualize the mutual influence of different components within the community on aggregate and population health. The nursing process includes attention to the aggregate at each step, assessment of the aggregate, nursing diagnosis of the aggregate, planning for the aggregate, and intervention and evaluation at the aggregate level.
Organization
Chapters cover the application of the community health nursing process to the special service needs in each of these areas. Basic nursing care strategies are applied to promote the health of these vulnerable, high-risk groups.
Special Features
New to this edition, these boxes present situations and considerations relevant to veteran care.
New content in this edition
Teaching and Learning Package
Acknowledgments
OUTLINE
Health
Describe the purpose of Healthy People 2020 and give examples of thematic areas that comprise the national health targets. Discuss community/public health nursing practice in relation to essential public health functions and essential services.
KEY TERMS
The main goal of public health nursing is to maintain the health of the community and surrounding population by focusing on health promotion and health maintenance of individuals, families and groups within the community. Public health assumes that it is society's responsibility to provide for the basic needs of the people.
Definitions of Health and Community
For example, health has been defined as "a state of well-being in which the person is able to use purposeful, adaptive responses and processes physically, mentally, emotionally, spiritually, and socially." For example, some writers use the individual or "person" as the unit of analysis and exclude it.
Community
In recent nursing literature, community has been defined as “a collection of people who interact with each other and whose . A solution community is a collection of people who form a group specifically to address a common need or concern.
Determinants of Health and Disease
Public health experts have found that health has improved over the last 100 years, largely because people get sick less often (Russo, 2011; McKeown, 2003). Community and public health nurses need to understand these concepts and realize that health and disease are influenced by a web of factors, some of which can be changed (e.g., individual behaviors such as tobacco use, diet, physical activity) and others that are not (e.g., genetics, age, sex).
Indicators of Health and Illness
HEALTHY PEOPLE 2020 Leading Health Indicator Topics
Finally, if a public health nurse works in a state-sponsored AIDS clinic and recognizes an increase in the number of women testing positive for HIV, the nurse must report all findings to the appropriate agencies. The nurse should then participate in investigative efforts to determine what is causing the increase and work to address identified threats or risks.
Definition and Focus of Public Health and Community Health
In a key action, the Institute of Medicine (IOM) (1988) identified the following three primary functions of public health: assessment,. The term community health expands the field of public health to include organized health efforts at the community level through both governmental and private efforts.
FUNCTIONS
All nurses working in community settings need to develop knowledge and skills related to each of these key functions. These efforts at the federal and state levels focus on providing support and advisory services to public health structures at the local level.
SERVICES
Scientific methods of public health that assess biostatistics, epidemiology, and population needs provide a method for measuring characteristics and health indicators and disease patterns within a community. In 1994, the American Public Health Association compiled a list of ten essential public health services that the United States provides
Preventive Approach to Health
Health Promotion and Levels of Prevention
Much of community health care practice is aimed at preventing the progression of the disease at the earliest feasible period or stage using the appropriate level(s) of prevention. The concepts of prevention and population-based care play a prominent role in a conceptual orientation to nursing practice called 'upstream thinking'. This orientation is derived from a.
ETHICAL INSIGHTS
The author then asks health providers to critically examine the relative weights of their activities versus disease response versus disease prevention. For these nurses, this theme provides validation of their daily efforts to prevent disease in at-risk populations in schools, workplaces, and clinics throughout their local communities and in the larger world.
Inequities: Distribution of Resources
Ethical questions commonly encountered in public health and public health nursing practice include the following: Should resources (eg, free or low-cost immunizations) be made available to everyone, even those with insurance who will pay for care. Should public health nurses serve anyone who meets financial need guidelines, regardless of medical need.
Prevention versus Cure
Whether illegal aliens or people working with a "green card" should receive the same level of health care services that are available to citizens. In industrialized countries, life expectancy at birth is not related to the level of health care spending; in developing countries, life expectancy is closely related to the level of economic development and education.
Healthy People 2020
While many of its objectives were not met, the initiative was extremely successful in raising awareness among providers of health behaviors and health promotion activities. The final assessment and analysis of the Healthy People 2010 goals showed decidedly mixed progress for the nation.
HEALTHY PEOPLE 2020 Topic Areas
Of particular concern were the poor responses in two of the focus areas: arthritis, osteoporosis, and osteoporosis.
Definition and Focus of Public Health Nursing, Community Health Nursing,
Public and Community Health Nursing
In 1980, the ANA defined community health care as "the synthesis of nursing practice and public health practice applied to promote and preserve the health of the population" (ANA, 1980, p. 2). ANA (2013) elaborated by explaining that public health care practice “is population-focused, with the goals of promoting health and.
RESEARCH HIGHLIGHTS
Thus, public health nursing is defined as "the practice of promoting and protecting the health of the population using knowledge from nursing, social and public health sciences" (ANA/APHA, 1996, p. 5). Some nursing writers will continue to use community nursing as a global or umbrella term and public health nursing as a component or subset.
Public Health Nursing Research Agenda
In the updated standards, the definition was again "public health nurse" and ANA used the definition presented by the American Public Health Association (APHA) Committee on Public Health Nursing (1996). Ultimately, it is anticipated that PHN research will proactively contribute to the effectiveness of the public health system and create healthier communities.
Community-Based Nursing
The purpose of the agenda is to help PHN scientists contribute to a better understanding of how to improve health and reduce health disparities between the population by increasing the evidence base related to the outcomes of practice and by influence related health policies. The group encouraged the use of the agenda to guide and inform research programs, influence funding priorities, and be incorporated into doctoral PHN education through course and curriculum development.
Community and Public Health Nursing Practice
OF PRACTICE FOR PUBLIC HEALTH NURSING
Data from American Nurses Association: Public Health Nursing: Scope and Standards of Practice, ed 2, Silver Spring, MD, 2013, author. Current and prospective community nurses should study these competencies to understand the practice parameters and skills required for public health practice.
Population-Focused Practice and Community/Public Health Nursing
Community nursing practice requires the following types of data for a scientific approach and population focus: (1) Modified from Quad Council of Public Health Nursing Organizations: Public Health Nursing Competences, Washington, DC, 2011, author.
Community Health Interventions
Adapted from Section of Public Health Nursing, Minnesota Department of Health: Public health ..lt;http://www.health.state.mn.us/divs/cfh/connect/index.cfm? . article=phstories.search>.). Private associations, such as the American Diabetes Association, employ health nurses for their organization and health-related skills.
The Public Health Intervention Wheel
The Intervention Wheel contains three important elements: (1) it is population-based; (2) contains three levels of practice (community, systems, and individual/family); and (3) identifies and defines 17 public health interventions. Edited by Keller LO, Strohschein S, Lia-Hoagberg B, Schaffer MA: Population-based public health interventions: practice-based and evidence-based.
Community Health Nursing, Managed Care, and Health Reform
The quality and cost of all health care services are linked together across the health care continuum. Community and public health nurses have an opportunity to share their expertise regarding population-based approaches to health care for groups of individuals in health care settings.
Summary
Public health nurses must work in partnership with colleagues in managed care settings to improve community health.
Learning Activities
EVOLVE WEBSITE
A review of factors influencing the use of home and community-based long-term care: trends and implications for the nursing workforce.
Historical Factors
Compare the application of public health principles to the country's major health problems in the early twentieth century (ie, acute disease) with that in the early twenty-first century (ie, chronic disease). Discuss the major contemporary issues facing community/public health nursing and trace the historical roots to the present.
Evolution of Health in Western Populations
Aggregate Impact on Health
Furthermore, although the stages describe the general development of the Western world, it is important to realize that each stage still exists in civilization today. Public health providers should be aware that populations from each stage represent a wide variety of people with different cultural backgrounds.
Hunting and Gathering Stage
Settled Village Stage
Preindustrial Cities Stage
Industrial Cities Stage
Pandemic The existence of a disease in a large segment of the population: a global epidemic (for example, human immunodeficiency virus, acquired immunodeficiency syndrome, and annual outbreaks of influenza type A).
Present Stage
Evolution of Early Public Health Efforts
It is important to note that, like the history of human disease, public health efforts are in various stages of development around the world, and this brief history suggests a Western point of view.
Prerecorded Historic Times
Classical Times
However, residents of the overcrowded Roman slums had no access to public health facilities such as sewers and latrines, and their health suffered. In the early years of the Roman Republic, priests were believed to mediate disease and often dispense medicine.
HEALTH SERVICES
Middle Ages
Modern public health practices such as isolation, disinfection, and ship quarantines arose in response to bubonic plague (Box 2-2).
LIFE IN AN ENGLISH HOUSEHOLD IN THE SIXTEENTH CENTURY
UNITED STATES
The country averages 13 plague cases per year, with most of these cases occurring in New Mexico, California, Texas and Colorado. In 2006, 13 cases of human plague were reported, resulting in two fatalities in the United States.
The Renaissance
Eighteenth Century
Orphans and poor children were wards of the parish; therefore the parish forced these young children to work long hours in parish workhouses (George, 1925). Jenner's contribution was significant because about 95% of the population suffered from smallpox in the eighteenth century and about 10% of the population died from smallpox.
Nineteenth Century
Edwin Chadwick drew attention to the consequences of unsanitary conditions that resulted in health disparities that shortened the lifespan of the working class in particular. In 1849, a German pathologist named Rudolf Virchow argued for social action—improving people's lives by improving.
Advent of Modern Health Care
Evolution of Modern Nursing
She and 40 other nurses traveled to Scutari, which was part of the Ottoman Empire at the time. Nightingale distributed her reports to members of Parliament and to army doctors and commanders (Kopf, 1978).
Establishment of Modern Medical Care and Public Health Practice
Notes on Matters Affecting the Health, Efficiency and Hospitalization of the British Army, London, 1858, Harrison and Sons; B, public domain; politeness. While experimenting with winemaking in 1854, he proposed the theory of the existence of germs.
STATISTICAL METHODS IN COMMUNITY ASSESSMENT
The emergence of the germ theory of disease focused diagnosis and treatment on the individual organism and individual disease. In the United States, the Carnegie Commission appointed Abraham Flexner to evaluate medical schools across the country on the German model.
Community Caregiver
AGENT THEORY
Indeed, many modern medicines are based on the medicines of primitive cultures (e.g. eucalyptus, coca and opium) (Hughes, 1978). In contrast, "modern medicine" in the mid-1900s recommended that women remain in bed, often for much longer periods (Smith, 1979).
HISTORICAL METHODOLOGY FOR NURSING RESEARCH
Traditional obstetric practices, for example, had women get out of bed within 24 hours of giving birth to help "clean out" the lochia.
Establishment of Public Health Nursing
Public nursing as a holistic approach to nursing developed in the late nineteenth and early twentieth centuries.
England
In 1893, Nightingale pointed out that the ward nurse should be a health teacher and nurse to the sick in the home. The model entrusted the district nurse with care for the sick in the home and the care visitor with health education at home.
United States
The Ladies Section of the Manchester and Salford Sanitary Association began conducting health visits in Manchester in 1862. A nurse found a boy at school whose skin had begun to flake from scarlet fever and took him to the Department of Health president in an attempt to place doctors. schools.
HENRY STREET
However, following acceptance of the germ theory and epidemiological techniques of data analysis in the early 1900s, public health efforts shifted to consideration of factors, including biological, environmental, and economic, that contributed to the high infant mortality rate. Traditional models of public health care and visiting nursing by home health agencies became increasingly common over the next decades, but declined toward the end of the century due to changes in health care funding.
Consequences for the Health of Aggregates
Twenty-First Century New Causes of Mortality
Hygeia versus Panacea
Additional Theories of Disease Causation
Najman argued that each theory explains a particular disease under certain conditions, but no single theory explains all diseases.
Social Changes and Community Health Nursing
Implementation of the Patient Protection and Affordable Care Act (PPACA) should address many of the disparities that have persisted for decades. Box 2-6 provides a summary of some of the dramatic effects of public health activities on the health of Americans over the past 100 years.
ACHIEVEMENTS—UNITED STATES, 1900- 2010
Under the 1980 legislation, safer workplaces resulted in an additional 40% reduction in the rate of fatal occupational injuries by the end of the century. The results showed that the image of nursing has improved dramatically compared to the negative perception of the 1850s.
Challenges for Community and Public Health Nursing
Adapted from Hanggi-Myers LJ: The Origins and History of the First Public Health Nurses/Community Health Nurses in Louisiana, Dissertation Abstracts, New Orleans, 1996, Louisiana State University Medical Center. Origins and History of the First Public Health/Patron Nurses in Louisiana Dissertation Abstracts.
Thinking Upstream
Despite all these challenges, how can nurses hope to impact the health of the public in a significant way? Despite these and many more challenges, how can nurses succeed in their goal of improving public health?
Thinking Upstream: Examining the Root Causes of Poor Health
McKinlay used this analogy to illustrate the ultimate futility of "downstream efforts," which are characterized by short-term, individual-based interventions and challenged health care providers to focus more of their energies. Downstream healthcare takes place in our emergency departments, critical care units and many other healthcare environments with a focus on disease management.
Historical Perspectives on Nursing Theory
How Theory Provides Direction to Nursing
PROPOSED BY NURSING THEORISTS
A set of ideas, assumptions, or hypotheses that provide some degree of prediction and/or explanation of the world” (Pryjmachuk, 1996, p. 679). Within the profession, definitions of theory usually refer to a set of relational concepts and statements and the purpose of the theory.
Microscopic Versus Macroscopic
Approaches to the Conceptualization of Community Health Problems
A common dilemma in community health practice is the tension between working on behalf of individuals and working on behalf of a population. Several nursing organizations focus on this population, and one organization, the Quaternary Council of Public Health Nursing, consists of.
Assessing a Theory’s Scope in
Relation to Community Health Nursing
Review of Theoretical Approaches
The Individual Is the Focus of Change
Orem’s Self-Care Deficit Theory of Nursing
Kennedy (1989) maintained that self-care deficit theory assumes that people are able to exercise purposeful control over their environment in the pursuit of health; however, people may have little control over the physical or social aspects of their work environment. Based on this thesis, she concluded that the self-care model is incompatible with the practice domain of occupational health care.
The Health Belief Model
Over the years, a number of authors have proposed expanding the scope of HBM to address health promotion and illness behavior (Kirscht, 1974; Pender, 1987) and merging its concepts with other theories describing health behavior (Cummings, Becker, & Malie, 1980). The following section contains a brief personal account of the author's views, addressing the strengths and limitations of the model.
The Upstream View: Society Is the Focus of Change
The model reflects a type of theoretical perspective that has dominated nursing education and behavioral health for many years. The narrow scope of the model is both its strength and its limitation: nurses are not challenged to investigate the root causes of health opportunities and behaviors in the communities we serve.
Milio’s Framework for Prevention
Personal and societal resources influence the range of health-promoting or health-damaging choices available to individuals. Comparison of the HBM and Milio's health concepts Milio's health resources bear some resemblance to the concepts in the HBM.
Critical Theoretical Perspective
The priorities of any health care system must be based on the needs of the clients/population and not the health care providers. Application of a critical theoretical perspective can be seen when health care is used as a form of social control.
Social Injustice in Community-Based Practice
Fortunately, these worldviews of health delivery systems are not mutually exclusive, and nurses can understand the duality of health care needs of individuals and populations. The Social Determinants of Health theme area within Healthy People 2020 is designed to identify ways to create social and physical.
NURSES WORK IN ENVIRONMENTAL HEALTH IN A VARIETY OF WAYS
