NUR 4636C Community Partnered Care Fall 1999

1. NUR 4636C Community Partnered CareFall 1999 Health: A Community View Regina L. Payne, EdD, RN, CWOCN Anne Nolan, MS, RN, FRCNA

2. Health: A Community View • How do we define health?  Depends on who is defining it & why defining it  And on the unit of analysis: individual, family, community, aggregate, population • Are there common characteristics of health regardless of who or why defining it & unit of analysis?

3. Health: A Community View • Definitions of Health • Personal • 80 year old female caretaker of husband • Relative • Surgeon • Mexican migrant farm laborer • Director of Nursing County Health Department • School health nurse

4. Health: A Community View • Definitions • WHO, 1986: …extent to which an individual or group …realize aspirations and satisfy needs … change or cope with the environment. … Health … resource for everyday life … not object of living … positive concept … social and personal … physical capacities.” • DON: Health is the extent to which an individual or group is able, on the one hand, to realize expectations and satisfy needs, and, on the other hand, to change or cope with the environment (WHO, 1984, p.3).

5. Health: A Community View • Definition & Focus of Public Health & Community Health • What is Public Health? • Definition: How is Public Health different from Private Health? • Focus: Health promotion/education & disease prevention • Examples of PH Health Promotion/Education Activities? • PH Disease Prevention Activities? • Primary Prevention • Secondary Prevention • Tertiary Prevention

6. Health: A Community View • Focus of Public Health & Community Health • Focus of Public Health versus Focus of Nonpublic Health • National Level: • Local level:

7. Health: A Community View • Focus of Public Health & Community Health • Focus of Public Health • COMMUNICABLE DISEASE CONTROL (Prevention?) • Examples: • HEALTH EDUCATION (Level of Prevention?) • Examples: • EARLY DIAGNOSIS of DISEASE (Level of Prevention? • Examples: • SOCIAL PROGRAMMING (Level of Prevention?) • Examples:

8. Health: A Community View • Focus of Public Health & Community Health • Functions ofPublic Health • ASSESSMENT: WHAT IS THE HEALTH STATUS OF THE POPULATION? • Proxy Measure: Disease • ASSURANCE: IS CARE AVAILABLE? • Uninsured Children • Accidental Deaths • POLICY DEVELOPMENT: LOCAL, STATE, & FEDERAL

9. Health: A Community View • Focus of Public Health & Community Health • Focus of Community Health • Health of local communities organized through partnerships between pubic tax supported & private agencies: American Heart Assoc, American Cancer Society, hospitals, schools, HDs, United Way agencies, universities • Examples of partnerships you have been involved in which focused on the health of a community

10. Health: A Community View • Public Health and Community Health Nursing • How would you define and ‘level’ each of the following? • Community • Family • Individual • Aggregate • Population • Group • Neighborhood

11. Health: A Community View • Population Based and Aggregate Based Care • Population: Large collection individuals with common personal or environmental characteristic(s):Give examples: • Geographic locale: • Special interest: • Other characteristics: • Subpopulations-Special groups within populations: • High risk infants under 1 year age • Unmarried adolescent mothers • Grade Schoolers (5-11 year olds) • Population Based Care: Define: • CHN Role: Specialist? Generalist? Where would this person work with populations?

12. Health: A Community View • Population Based and Aggregate Based Care • Aggregate: Group of individuals (smaller than population) with common personal or environmental characteristic(s): Example: • Geographic locale: • Special interest: • Other characteristics: • Other aggregate groups: • High risk infants under 1 year age: Hispanic, RCMA • Unmarried adolescent mothers: Lee County HD • Grade Schoolers (5-11 year olds): Rural Lee County • Aggregate Based Care: Define: • CHN Role: Specialist? Generalist? Where would this person work?

13. Health: A Community View • Public Health and Community Health Nursing • Public Health Nursing & Community Health Nursing • How does PHN differ from CHN? • What are the defining characteristics of each? • What is their focus of practice for each? • What are their goals? • What education and titles do nurses hold in each sphere?

14. Health: A Community View • Preventionistic Approach Marie is an 8 year old Haitian girl at San Carlos Park Grade School. You are the school nurse who has found that Marie has the following needs: • Understands little English; family speaks no English • Scored at 60th percentile for age/weight on growth chart • Has head lice, dental caries, & poor hygiene Identify short term goals & primary, secondary, and tertiary level coventions for Marie

15. Thinking Upstream • Microscopic vs Macroscopic Approaches • Microscopic Approach to Health Care • Focus: • Disease Causation: • Coventions: • MacroscopicApproach to Health Care • Focus: • Disease Causation: • Coventions:

16. Thinking Upstream • Models for Public Health Planning • Individual Focus: Thinking Downstream • Orem: Self Care Deficit Theory • Health Belief Model • Societal Focus: Thinking Upstream • Milio’s Framework for Prevention • Critical Social Theory Identify one health problem of a population in FGCU service region. Formulate coventions using downstream/upstream approaches. How are these analogous to microscopic/macroscopic approaches and individual/societal foci?

17. Historical Factors: Community Health in Context • Identify one highlight of historical significance in public health for class discussion (Text, Chapter 2) • Why did you select this event? • Is there a counterpart event today?