Community Health Nursing Theoretical basis of Community Health Nursing Chapter 14
WHEN THE CLIENT IS A COMMUNITY: characteristics of community health practice • Community health nursing is a specialty in which the unit of care is a specific community or aggregate and the nurse has responsibility to promote group health • The goal of this specialty is health improvement of the community.
WHEN THE CLIENT IS A COMMUNITY: characteristics of community health practice • The skills required for excellence in community health nursing practice include • epidemiology, research, teaching, community organizing, and interpersonal relational care,
WHEN THE CLIENT IS A COMMUNITY: characteristics of community health practice • community health nursing is characterized • by community-oriented, population-focused care and is based on interpersonal relationships.
Community-Oriented, Population. Focused Care • A community is a group of people who have some characteristics in common, • are bounded by time, interact with one another, and feel a connection to one another. • They share similar experiences and concerns, and they often influence one another’s behavior.
Community-orientation, population-focused care • Is a process that is actively shaped by the unique experiences knowledge, concerns, values, beliefs, and culture of a given community.
Community-orientation, population-focused care • when the outbreak of a such disease, the nurse also • 1 - Uses disease-investigation skills to locate possible sources of infection • 2 - Determines how the community’s knowledge, values, beliefs, influence its interpretation of the disease, response to and prior experiences with infectious disease may outbreak, and treatment preferences
Community-orientation, population-focused care • 3 - Uses knowledge and suggestions gathered from the community to develop, in collaboration with other health professionals community-specific program to prevent future outbreaks
Community-orientation, population-focused care • A community-oriented nurse who provides nutritional counseling to a community considers the meaning of food in this culture, the types of food most commonly consumed, and the cooking methods most commonly used.
Community-orientation, population-focused care • A population • is any group of people who share at least one characteristic, such as age, gender, race, a particular risk factor, or disease. • Smokers and breast cancer survivors are two populations.
Relationship-based care • Incorporates, the value of establishing and maintaining a reciprocal, caring relationship with the community health nursing practice and is foundational to caring effectively for the community’s health.
Relationship-based care • A reciprocal, caring relationship with the community involves listening, participatory dialogue, and critical reflection, and it may also involve sociopolitical elements of practice such as advocacy, community empowerment, and movement to action
Theories and Models for CHN Practice • Theory: set of systematically interrelated concepts or hypotheses; explain or predict phenomena • Early theories: grand theories or conceptual models • Key to nursing theories: nursing metaparadigm concepts – Nursing – Client/patient – Health – Environment • Model: pictorial representation
Nightingale’s Theory of Environment • Focus on preventive care for populations • Use of observations to validate her hypothesis – Poor environmental conditions are bad for health. – Good environmental conditions reduce disease. • Others have added social services and health care in addition to environment as conditions for health.
Orem’s Self-Care Model • Communities with collective set of self-care actions and requirements affecting well-being of the group • Self-care deficit: demand exceeds client abilities related to: – Universal requirements – Developmental requirements – Health deviation requirements • Nursing care supports client • Specific theories: self-care deficit theory; theory of selfcare; theory of nursing system
Neuman's Health Care Systems Model • Open systems constantly and reciprocally interacting with environment • System > sum of parts • Wellness = parts interacting in harmony with each other and the system’s environment • Variables: physiologic, psychological, sociocultural, developmental • Each system with unique response to stressors and tension-producing stimuli • System response (see Fig. 14. 1) with boundaries: flexible line of resistance; normal line of defense; dynamic flexible line of defense
Rogers’ Model of the Science of Unitary Man • • • Based on systems theory Whole is greater than the sum of the parts Three principles: 1. Life proceeds in one direction along a rhythmic spiral. 2. Energy fields follow a certain wave pattern and organization. 3. Human and environmental energy fields interact simultaneously and mutually, leading to completeness and unity.
King’s Theory of Goal Attainment • Personal and interpersonal systems • In any nurse-client encounter, each comes with own goals and expectations • Success at goal achievement is possible only when nurse and client work together to set goals
Pender’s Health Promotion Model • Proactive set of behaviors to increase level of well-being and self-actualization • Individuals acting on environment; not reacting to stressors from environment • Modifying factors – Demographic factors – Biologic characteristics – Interpersonal influences – Situational factors – Behavioral factors
Roy’s Adaptation Model • Open adaptive systems, experiencing stimuli, developing coping mechanisms, and producing responses • Adaptive or maladaptive responses; provide feedback influencing amount & type of stimuli that can be handled in future • Regulator process: stimuli from internal and external environment processed for a response • Cognator process: perceptions, learning, judgment, and emotion considered in formulating response
Salmon Construct for PHN • Categories of nursing interventions – Education directed toward voluntary change in the attitudes and behavior of the subjects – Engineering directed at managing risk-related variables – Enforcement directed at mandatory regulation to achieve better health • Interventions target determinants in four categories: – Human/biologic, environmental, medical/technologic/organizational, and social
Minnesota Wheel – the Public Health Interventions Model • 17 different interventions • Three levels of public health practice: – Population-based community-focused practice – Systems-focused practice – Individual-focused practice (see Fig. 14. 2)
Principles of Public Health Nursing Principle 1: focus on community the client or unit of care is the population Principle 2: give priority to community needs the primary obligation is to achieve the greatest good for the greatest number of people or the population as a whole
Principles of Public Health Nursing Principle 3: Work in Partnership With the People the processes used by public health nurses include working with the client as equal partner. Principle 4: Focus on Primary Prevention primary prevention is the priority in selecting appropriate activities.
Principles of Public Health Nursing Principle 5: Promote a Healthful Environment public health nursing focuses on strategies that create healthy environmental, social, and economic conditions in which population may thrive.
Principles of Public Health Nursing Principle 6: Target All Who Might Benefit a public heath nurse is obligated to actively identify and reach out to all who might benefit from a specific activity or service
Principles of Public Health Nursing Principle 7: Promote Optimum Allocation of resources optimal use of available resources to assure the best overall improvement in the health of the population is a key element of the practice
Principles of Public Health Nursing Principle 8: Collaborate with Others in the Community collaboration with a variety of other professions, populations, organizations, and other stakeholder groups is the most effective way to promote and protect the health of the people
SOCIETAL INFLUENCES ON COMMUNITYORIENTED POPULATION-FOCUSED NURSING Social changes influence a community’s health. Community communicable disease. affect the availability of resources Contemporary community health nurses must be especially aware of the mutual interaction between nursing and technology
SOCIETAL INFLUENCES ON COMMUNITYORIENTED POPULATION-FOCUSED NURSING • Communication Technology • Genetic Engineering can be defined as gene manipulation in a laboratory setting • Global Economy • Migration is the act of moving from one region or country to another, either temporarily, seasonally, or permanently.
SOCIETAL INFLUENCES ON COMMUNITYORIENTED POPULATION-FOCUSED NURSING Terrorism is one way in which a small number of people who perceive that they have been unfairly treated can exert influence on a larger group or nation. Bioterrorism is the use of living organisms, such as bacteria, viruses, or other organic materials, to harm or intimidate others, in order to achieve political ends.
SOCIETAL INFLUENCES ON COMMUNITYORIENTED POPULATION-FOCUSED NURSING Climate changes can be considered societal changes because they may be influenced by economics