Part1:Growth of Public HealthThe emphasis on public health nursing has been varied and has changed over time. Given this chapter’s review of the important issues that nursing can address,what...

Part1:

Growth of Public Health

Cultural Influences in Nursing in Community Health

Chapter 1 Community-Oriented Nursing and Community-Based Nursing CHAPTER 1 Community-Oriented Nursing and Community-Based Nursing All items and derived items © 2014, 2010, 2006, 2002 by Mosby, an imprint of Elsevier Inc. * OBJECTIVES Describe the goal and core functions of public health and the services generally provided by practitioners of public health. Discuss the role of the public health nurse specialist and how the role influences nursing practice in the community. Explain community-based nursing practice. Describe community-oriented nursing practice. Examine how community-based nursing practice differs from community-oriented nursing practice. * All items and derived items © 2014, 2010, 2006, 2002 by Mosby, an imprint of Elsevier Inc. All items and derived items © 2014, 2010, 2006, 2002 by Mosby, an imprint of Elsevier Inc. INTRODUCTION Community-based nursing (CBN) Focus is on “illness care” of individuals and families across the lifespan. Growing costs of hospital care Community-oriented nursing Focus is on promoting quality of life Focus is on the health care of entire communities or populations as well as the health care of individuals, families, and groups Includes the specialty of public health nursing (PHN) Goal is to prevent disease and preserve, promote, restore, and protect health for the community and the population within it * All items and derived items © 2014, 2010, 2006, 2002 by Mosby, an imprint of Elsevier Inc. All items and derived items © 2014, 2010, 2006, 2002 by Mosby, an imprint of Elsevier Inc. More nurses are engaging in community-based nursing (CBN). In CBN, the focus is on “illness care” of individuals and families across the lifespan. Growing costs of hospital care is leading to more care being provided in community-based settings. Community-oriented nursing has a broader focus than CBN. It’s primary focus looks at both the health care of entire communities or populations as well as the health care of individuals, families, and groups. It includes the specialty of public health nursing. In community-oriented community health nursing the goal is to prevent disease and preserve, promote, restore, and protect health for the community and the population within it * WHAT IS PUBLIC HEALTH? Public Health Goal is to organize community efforts that will use scientific and technical knowledge to prevent disease and promote health. Benefits from Public Health Dramatic increase in life expectancy Decreased number of deaths from stroke, coronary heart disease, and cancer Declines in death rates of adults and children Population-focused PH approaches could help prevent up to 70% of early deaths in America, compared to only 10% for medical treatment. * All items and derived items © 2014, 2010, 2006, 2002 by Mosby, an imprint of Elsevier Inc. All items and derived items © 2014, 2010, 2006, 2002 by Mosby, an imprint of Elsevier Inc. * Public Health A scientific discipline that includes the study of epidemiology, statistics, and assessment—including attention to behavioral, cultural, and economic factors—as well as program planning and policy development. Public health is what members of a society do collectively to ensure that conditions exist in which people can be healthy. Benefits from Public Health Dramatic increase in life expectancy Decreased number of deaths from stroke, coronary heart disease, and cancer Declines in death rates of adults and children Population-focused PH approaches could help prevent up to 70% of early deaths in America, compared to only 10% for medical treatment Public health practice provides many benefits, especially considering the small portion of the health care budget in the United States that is used for this prevention and population-focused specialty. Imagine how many more benefits the U.S. might see if more money was given toward public health practice. * All items and derived items © 2014, 2010, 2006, 2002 by Mosby, an imprint of Elsevier Inc. What is Public Health? (Cont.) All items and derived items © 2014, 2010, 2006, 2002 by Mosby, an imprint of Elsevier Inc. Affordable Care Act of 2010 created and charged the National Prevention Health Promotion and Public Health Council with developing the National Prevention and Health Promotion strategy to focus on community-oriented approaches to prevention and wellness in order to “reduce the incidence and burden of the leading causes of death and disability.” The Centers for Medicare and Medicaid Services estimated in 2008 only 3% (up from 1.5% in 1960) of all national health expenditures support population-focused public health functions, yet the impact was enormous. * PUBLIC HEALTH CORE FUNCTIONS Assessment Policy Development Assurance * All items and derived items © 2014, 2010, 2006, 2002 by Mosby, an imprint of Elsevier Inc. All items and derived items © 2014, 2010, 2006, 2002 by Mosby, an imprint of Elsevier Inc. * Assessment Systematic data collection on the population, monitoring the population’s health status, and making information available about the health of the community. Policy Development Efforts to develop policies that support the health of the population, including using a scientific knowledge base to make policy decisions. Assurance Making sure that essential community-oriented health services are available Includes providing essential personal health services for individuals as well as a competent PH workforce LEVELS OF HEALTH CARE SERVICES PYRAMID * See Figure 1-2. Each service level in the pyramid is important to the health of the population. The base of the pyramid shows the effective services that will support the top tiers and contribute to better health. Primary: both primary care and public health services that are designed to meet the basic needs of people in communities at an affordable cost. Secondary: services designed to detect and treat disease in the early acute stage. Tertiary: services designed to limit the progression of disease or disability. All tiers of the pyramid need to be adequately financed (U.S. Public Health Service, 1994/2008). * ESSENTIAL SERVICES OF PUBLIC HEALTH Monitor health status to identify community health problems. Diagnose and investigate health problems and hazards in the community. 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. Enforce laws and regulations that protect health and ensure safety. Link people to needed personal health services and ensure the provision of health care that is 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. * All items and derived items © 2014, 2010, 2006, 2002 by Mosby, an imprint of Elsevier Inc. All items and derived items © 2014, 2010, 2006, 2002 by Mosby, an imprint of Elsevier Inc. POPULATION-FOCUSED NURSING PRACTICE Population (or aggregate) Subpopulations Population-focused practice * All items and derived items © 2014, 2010, 2006, 2002 by Mosby, an imprint of Elsevier Inc. All items and derived items © 2014, 2010, 2006, 2002 by Mosby, an imprint of Elsevier Inc. Population: as a collection of individuals who share one or more personal or environmental characteristics. The term population may be used interchangeably with the term aggregate. Subpopulations: subsets of the population who share similar characteristics. For example, people older than 65 years who live in a residential home would be a subpopulation of a larger population of older persons in the community. In population-focused practice, problems are defined (assessments/diagnoses) and solutions (interventions), such as policy development or providing a given preventive service, are implemented for or with a defined population or subpopulation as opposed to diagnoses, interventions, and treatment carried out at the individual level. This contrasts with basic professional education in nursing, medicine, and other clinical disciplines, which emphasizes developing competence in decision making at the level of the individual client by assessing health status, making management decisions (ideally with the client), and evaluating the effects of care. * CHARACTERIZING PUBLIC HEALTH NURSING Population-focused Community-oriented Health and prevention focused Interventions at the community and/or population level Concern for the health of all members of the population or community, particularly vulnerable populations * All items and derived items © 2014, 2010, 2006, 2002 by Mosby, an imprint of Elsevier Inc. All items and derived items © 2014, 2010, 2006, 2002 by Mosby, an imprint of Elsevier Inc. * CHARACTERIZING PUBLIC HEALTH NURSING (CONT.) In public health nursing, the nurse often reaches out to those who might benefit from a service or intervention. In other forms of nursing, the client is more likely to seek out and request assistance. * All items and derived items © 2014, 2010, 2006, 2002 by Mosby, an imprint of Elsevier Inc. All items and derived items © 2014, 2010, 2006, 2002 by Mosby, an imprint of Elsevier Inc. TYPES OF PRACTICE FOCUS IN NURSING All items and derived items © 2014, 2010, 2006, 2002 by Mosby, an imprint of Elsevier Inc. * Focus is on providing services to individuals rather than a population, while maintaining an appreciation for the values of the community Example: Developmental screening tests of children in the Head Start preschool program to evaluate each child Emphasizes health protection, health promotion, and disease prevention of a population Example: Look at all children in the Head Start preschool program to evaluate if the program is achieving its goals Population Focused Individual, Family, and Group Focused All items and derived items © 2014, 2010, 2006, 2002 by Mosby, an imprint of Elsevier Inc. Community-oriented nursing can focus either on the community (population-focused) OR on individuals, families, and groups. Community-based nurse only focuses on individuals and families. * PRACTICE FOCUSING ON INDIVIDUALS, FAMILIES, AND GROUPS Community-Oriented Nursing Community-Based Nursing * All items and derived items © 2014, 2010, 2006, 2002 by Mosby, an imprint of Elsevier Inc. All items and derived items © 2014, 2010, 2006, 2002 by Mosby, an imprint of Elsevier Inc. Community-Oriented Nursing Nursing that has as its primary focus the health care of either the community or a population of individuals, families, and groups. Broader in scope than community-based practice. A form of care in which the nurse provides health care after doing a community diagnosis to determine what conditions need to be altered in order for individuals, families, and groups in the community to stay healthy. Community-Based Nursing The provision of acute care and care for chronic health problems to individuals and families in the community Occurs outside an institution; services are provided to individuals and families in a community * FOUR KEY NURSING MODES IN THE COMMUNITY Community-oriented nursing practice Public health nursing practice Community-based nursing practice Community health nursing practice * All items and derived items © 2014, 2010, 2006, 2002 by Mosby, an imprint of Elsevier Inc. All items and derived items © 2014, 2010, 2006, 2002 by Mosby, an imprint of Elsevier Inc. * FOUR KEY NURSING MODES IN THE COMMUNITY (CONT.) All items and derived items © 2014, 2010, 2006, 2002 by Mosby, an imprint of Elsevier Inc. * Goal Focus is on “illness care” of individuals and families across the life span Provide acute and chronic illness care and the provision of comprehensive, coordinated, and continuous care A setting-specific practice, care is provided where people live, work, and attend school Goal Prevent disease and disability; promote, protect, and maintain health Focus is on “health care” of individuals, families, and groups in community Provide health care to promote quality of life Community diagnosis, health surveillance, monitoring and evaluation of community and population Community-based nursing Community-oriented nursing All items and derived items © 2014, 2010, 2006, 2002 by Mosby, an imprint of Elsevier Inc. FOUR KEY NURSING MODES IN THE COMMUNITY (CONT.) All items and derived items © 2014, 2010, 2006, 2002 by Mosby, an imprint of Elsevier Inc. * Goal Preserve, protect, promote, or maintain health of individuals, families, and groups in a community Practice focus Health of individuals, families, and groups, and how their health status affects the community as a whole Goal Prevent disease and disability and promote and protect the community as a whole Practice focus The community as a whole The effect of the community’s health status (resources) on the health of individuals, families and groups Community Health Nursing Practice Public Health Nursing Practice All items and derived items © 2014, 2010, 2006, 2002 by Mosby, an imprint of Elsevier Inc. * CHALLENGES FOR THE FUTURE Current trend to move more care into community settings and to reduce the number of hospital days for “sick” clients Community care is less expensive Community care is more appealing to people who prefer to remain at home rather than be treated in a hospital This trend is expected to grow and with it the role of the nurse in community settings will likewise grow and continue to change * All items and derived items © 2014, 2010, 2006, 2002 by Mosby, an imprint of Elsevier Inc. All items and derived items © 2014, 2010, 2006, 2002 by Mosby, an imprint of Elsevier Inc. There are many factors that will affect the changing role of the nurse in the community, such as the new and emerging infectious diseases, the need