Community Health Nursing

1. Community Health Nursing Module 11

2. Community Health Nursing (ANA, 1986) “The synthesis of nursing practice and public health practice applied to promoting and preserving the health of populations”

3. Community Health Definitions • Community - a group of people sharing common needs, interests, resources and environments. • Population - a statistical aggregate or subgroup of people with similar or identical characteristics; may or may not interact with one another. • Community HealthNursing - nursing care that takes place outside of acute-care settings; meets its goals by identifying problems and supporting community participation in the process of preserving and improving the health of community. The focus is on the health of the larger group rather than the health of the individual. • Public HealthNursing - subset of Community Health Nursing; goal is primarily improving the health of the entire community.

4. Communities:Essential Functions • Production, distribution or consumption of items • Socialization • Transmission of culture • Provision of norms/social controls • Provision of mutual respect

5. Communities:Four Critical Attributes • Group orientation • Bond among individuals • Human interaction • Collective action

6. 7 Patterns in a Health Sustainable Community • Cultivates leadership everywhere • Creates a sense of community • Connects people and resources • Knows itself • Practices ongoing dialogue • Embraces diversity • Shapes its future

7. Goal of Community Health Programs • “To improve the levels of health of the community” • First, identify potential and existing community health problems • Unique to each city

8. Community Health Programs • World Health Organization (WHO) • Healthy People 2010 • Department of Health and Human Services (DHS) • Public Health Department • (See Study Guide #2 for more extensive list)

9. World Health Organization • Founded in 1948 to give worldwide guidance in health, set standards of health, cooperate with governments in strengthening national health programs, and develop and transfer health technology, information, and standards.

10. Healthy People 2010 • 10-year plan and 10 goals for the health of the U.S. to promote healthy behaviors • Builds on original Healthy People initiative originated under President Carter. • An initiative of the Department of Health and Human Services (DHS)

11. Healthy People 2010 • 2 Goals: • Increase quality and years of healthy life • Eliminate health disparities • 28 Focus Areas • 467 specific objectives covering all ages

12. Healthy People 2010 • Steps/Goals • Reducing the Burden of Disease • Obesity • Diabetes • Asthma • Cancer • Heart Disease and Stroke

13. Healthy People 2010 • Addressing Risk Factors • Physical Inactivity • Poor Nutrition • Tobacco Use • Youth Risk Taking

14. Steps to a Healthier US • The President’s Health and Fitness Initiative • Created by Presidential Executive Order – June 2002

15. Healthier US Mission • “Focus on Health” pillars • Be physically active • Eat a nutritious diet • Get preventative screenings • Make healthy choices • To prevent disease, disability and death and help Americans lead safer, healthier, long lives

16. Healthier US, A Collaborative Effort • Health and Human Services (HHS) Agencies Involved in Steps to a Healthier US • Administration on Aging • Administration for Children and Families • Agency for Healthcare Research and Quality • Centers for Disease Control and Prevention (CDC) • Centers for Medicare and Medicaid Services • Food and Drug Administration • Health Resources and Services Administration • Indian Health Services • National Institutes of Health (NIH) • Substance Abuse and Mental Health Services Administration

17. DHHS Top 10 National Goals Targeted at Ensuring Healthy Communities and Individuals • Physical activity • Overweight and obesity • Tobacco use • Mental health • Responsible sexual behavior • Injury and violence • Substance abuse • Environmental quality • Immunizations • Access to health care services

18. Public Health • Focuses on assessing and identifying subpopulations at high risk or threat of disease or, at high risk of poor recovery • Makes sure resources and services are available and accessible to this population • Includes the study and practice of techniques that protect communities from epidemics, toxic exposure • Determines the risk for environmental disasters • Sets policy • Enforces laws that provide a safe supply of water and food

19. Public Health • Includes various governmental agencies: • Center for Disease Control and Prevention (CDC) • Food and Drug Administration (FDA) • National Institutes of Health (NIH) • All are active in maintaining public health • Each of 50 states has a health department in which at least one physician is the Public Health Officer

20. Community Health Assessment • A systematic way to determine the health status, resources or needs of a population. • Community health requires a population-based approach with attention given to the economic, social and political environments of the community as they impact a community’s health.

21. Steps of the Population-based Approach • Epidemiological research – The first step is to gather health data about the community, analyze the data and then develop a plan. • Needs assessment – This assessment includes systematically assessing what a community requires to maintain the best health for (or prevent or treat disease in) its members. All providers, clients and other key parties must be included in the assessment.

22. Steps of the Population-based Approach • Program Planning –Identifying the current situation or incident that needs improvement or change, indicating the desired outcome, and then designing a series of steps to move from the current situation to the desired situation. • Evaluation – A systematic inquiry to determine if the program followed its plan and met its goals.

23. Gathering Data:Epidemiology • Concerns of epidemiology include accidents, suicide, climate, toxic agents such as lead, air pollution and catastrophes due to ionizing radiation. • Term derives from the word epidemic which is an outbreak of disease that suddenly affects a large group of persons in a geographic region or defined population group.

24. Epidemiological Perspective • Looks at similarities among persons or populations that do or do not develop an illness. • Studies health related issues. • Considers belief that health status is dependent on multi-factorial causes among agent, host and environment

25. Epidemic vs. Pandemic • “Epidemic” = excessively communicable, contagious, disseminated, prevalent or widespread. • “Pandemic” = an exceptionally widespread epidemic that affects a very high proportion of the population or populations throughout the world; extraordinarily widespread diseases with global impact. Examples: AIDs, malaria, and influenza.

26. School & rural nursing Public health Home health Camp nurse Parish nurse Occupation health nurse Roles and Settings for Community-Based Nursing • Individuals • Families • Groups • General community

27. CHN Mission • Health Promotion • Physical health, mental health, and social and environmental health. • Includes individuals’ and communities’ abilities to cope with changes (environmental, social) and to maintain overall health and well-being. • Health Protection • Workplace safety and health, food and drug safety, and other health/safety areas, as well as the regulations that provide for them. • Avoiding illness and its consequences.

28. CHN Mission(continued) • Health Balance • A state of well-being that results from a healthy interaction among a person’s body, mind, spirit and environment • Disease Prevention • Includes activities designed to protect people from disease and its consequences • Includes the three levels of disease prevention: Primary, Secondary and Tertiary Prevention • Social Justice • Ensuring basic needs are met (adequate income and health protection)

29. CHN Practice • Builds caring relationships with families and communities. • Acts as a participant and facilitator rather than just a dispenser of medications or information. • Fosters mutual respect from both the giver and the receiver of care (effective care requires cooperation). • Understands and works with diversity and differences. • Focuses on populations or subpopulations rather than individual-based practice.

30. CHN Practice(continued) • Focuses on wellness, not sickness. • Focuses on prevention, not just treatment of problems. • Assists people and communities make their own decisions regarding health care (empowerment). • Assists those with existing health conditions to maximize their potential and prevent deterioration, if possible.

31. CHN Practice(continued) • Works in partnership with the community to address and support public health needs with education and referrals. • Responds to communicable disease needs.

32. CHN Practice(continued) • CHN recognizes health as “a state of complete physical, mental and social well-being and not merely the absence of disease and infirmity.” (W.H.O.) • Holistic focus; works with clients along the Wellness/Illness continuum.

33. The Illness/Wellness Continuum Photo Source: courtesy of Eastern Michigan University, http://www.emunix.emich.edu/~bogle/wellness%20continuum.jpg

34. Preventative Nursing • A branch of nursing aimed at preventing the occurrence of both mental and physical illnesses and diseases. • The nurse, as a member of a team of professionals, has the opportunity to emphasize and implement health care services to promote health and prevent disease.

35. Preventative Nursing (continued) Nursing expertise and general professional competence can also be used in supporting community action at all levels for the promotion of public health. There are three levels of preventative nursing: • Primary Prevention • Secondary Prevention • Tertiary Prevention

36. Nurse’s Role In Prevention • Primary - prevent homelessness by identifying and eliminating risks for this. Refer those with psychiatric disorders to specialists. • Secondary - refer to financial assistance, food supplements, assist finding shelter. • Tertiary - prevent recurrence of poverty, health problems, homelessness. Make referrals, educate.

37. Primary Prevention • Is applied to a generally healthy population. • Aim is general health promotion. • Involves measures taken to keep illness or injuries from occurring. • Includes whatever intervention is required to provide a health-promoting environment: • In the home • In schools • In public places • In the workplace • Includes good nutrition, adequate clothing, shelter, rest and recreation. • Health education.

38. Primary Prevention • Health education includes sex education and realistic plans for retirement for the aging population. • Areas of emphasis include protective measures such as immunizations, environmental sanitation, accident prevention and protection from environmental hazards (Occupational Safety and Health Administration - OSHA).

39. Primary Prevention(continued) • Promotes changes in lifestyle through behavioral therapies to those areas that represent major health risks: • Smoking • Obesity • Sedentary life-styles • Improper diet • Alcohol and drug abuse • Sexual promiscuity • Not practicing safe sex • Falls • Preventing automobile accidents

40. Primary Prevention - Interventions • Primary prevention: prevent the initial occurrence of the disease or injury • Immunization clinics • Smoking cessation • Tobacco chewing cessation • Sex education • Use of infant car seats, seat belts • Family planning • Dietary teaching and exercise • Water fluoridation

41. Secondary Prevention • Aimed at early recognition and treatment of disease • Includes general nursing interventions and teaching of early signs of disease. • These include but are not limited to glaucoma, obesity and cancer.

42. Secondary Prevention - Interventions Secondary-early detection: • Testicular self-exam • Blood pressure and cholesterol screening • Diabetes screening • HIV screening • Mammograms, pap smears • TB screening for those at risk • Hearing and vision screening

43. Tertiary Prevention • The goal is to prevent further deterioration of physical and mental functioning. • Individuals involved have an existing illness or disability whose impact on their lives is lessened through tertiary prevention. • To help maintain whatever residual function is available for maximum enjoyment of and participation in life’s activities. • Includes nursing care for patients with incurable diseases.

44. Tertiary Prevention(continued) • Patient education concerning how to manage and optimize new level of wellness associated with already diagnosed diseases and conditions. Examples include Parkinson’s disease, multiple sclerosis and cancer. • Rehabilitation services are an essential part of tertiary prevention.

45. Tertiary Prevention - Interventions • Tertiary Prevention-maximize recovery after an injury or illness including rehabilitative care. • Dietary education on low-fat, low-sodium diet or other prescribed diets. • Post-stroke exercise, speech or occupational therapy. • Nutritional counseling to support clients with HIV or AIDS • Foot care, eye exams and renal function studies in diabetic clients. • Swim therapy for clients with disabilities, rheumatologic or musculoskeletal health issues.

46. Preventative Nursing Case Study A group of elders living in a senior center are concerned about their risk for stroke. They have asked you, as their community health nurse, to address their concerns. Using each of the three levels of prevention, identify an appropriate educational topic that would address these elders’ prevention needs.

47. The CHNs Role • To promote health and healthy behaviour in the community • To act as a health resource person for the community

48. The CHNs Role(continued) • To identify health issues which may impact the well-being of individuals, families, groups and communities. • To refer identified health issues to appropriate agencies and ensure that co-ordination of care occurs.

49. Priorities Motivation Previous experiences Lack of knowledge of available services Cultural factors Finances Other Barriers to Referral Process • Attitudes of health care professionals • Physical accessibility of resources • Cost of resource services • Time • Other

50. Infection Control from a Community Health Perspective Modes of defence against infection: • Natural immunity • Artificial immunity – Active/Passive • Altering the environment