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NSG 411 – WEEK 3 – COMMUNITY AS
CLIENT TEST
Community A collection of people interacting with one another because of geography, common interests, characteristics or goals. Goal Promote, preserve, and maintain the health of populations y the delivery of health services to individuals, family and groups in order to influence "community health". Characteristics of Community/Public Health Nursing Practice Community orientation, population focus, and county and interviewing Community orientation process actively shaped by the unique experiences, knowledge, concerns, values, beliefs, and culture of a given community Ex: Nutritional counseling to to a community of Hispanic older adults considers the meaning of food in their culture, the types of food most commonly consumed, and the cooking methods most commonly used Population focus use of population-based skills such as epidemiology, research in community assessment, and community organizing as the basis for interventions Counting and interviewing homeless (unhoused/unsheltered) people and based on these data, develop a program to provide food, clothing, shelter, health care and job training for this population Principles of public health nursing
Focus on community. Give priority to community needs.- greatest good for the greatest number of people/population as a whole Work in partnership with the people. Focus on primary prevention. Promote a healthful environment. Target all who might benefit. Promote optimum allocation of resources. Collaborate with others in the community. Public Health Nursing Intervention Wheel Public health nurses fulfill the public health’s essential services by implementing interventions to address public health problems and opportunities identified through a community assessment. Three levels of public health practice that are population-based Individual/family Community Systems Individual Level Changes knowledge, attitudes, beliefs, practices, and behaviors of individuals alone or as part of a family, class, or group Individuals receive services because they are identified as belonging to a population- at-risk. Ex: Pregnant Teen Mom Community level Changes community norms, community attitudes, community awareness, community practices, and community behaviors. They are directed toward entire populations within the community or occasionally toward target groups within those populations. Community-focused practice is measured in terms of what proportion of the population actually changes.
Systems Level Local and state public health departments routinely collect data from outpatient and hospital laboratories to detect the influenza virus. Facilities with people in close proximity to one another, such as long-term care facilities and schools, report when their residents or students report flu-like symptoms above a certain rate. Public Health Interventions - Disease and Health Event Investigation Disease and health event investigation systematically gathers and analyzes data regarding threats to the health of populations, ascertains the source of the threat, identifies cases and others at risk, and determines control measures. Ex. Zika Virus Public Health Interventions - Disease and Health Event Investigation - How? - Community Level The local health department shared information concerning mosquito surveillance; removing areas of stagnant water where mosquitoes lay eggs; control of larvae, pupae and adult mosquitoes; and many resources that provide instructions on mosquito control strategies. Zika Prevention Education - Brazil Hydrocephalus - Concern around pregnant women - How to limit the spread of this disease. Public Health Interventions - Outreach locating people at risk and providing services or information Examples - community health fair, mobile clinic, home visits How? Travel away from the office, hospital, clinic, health department Bonnie's Bus - Outreach Bonnie's Bus was created in honor of Bonnie Wells Wilson the mother of Jo Statler, who succumbed to breast cancer in a remote area of the state with no access to screening mammography. Bonnie's Bus has a mission to provide breast cancer screening services to women in West Virginia, especially those in rural parts of the state with limited or no access to screening mammography.
http://wvucancer.org/cancer-prevention-control/bonnies-bus/ Public Health Interventions - Screening identifying people at risk or at preclinical stage Examples - mammography, cholesterol, BP screenings How? Use a screening tool, test, or survey Public Health Interventions - Case-Finding locates individual and families with identified risk factors and connects them to resources Example - people who test positive for STI or TB or depression How? Look at results of a screening and then follow-up Public Health Interventions - Referral and follow up connect people with services and check to be sure that they accessed them Examples - send person with diabetes to the diabetes educator or an endocrinologist; send child who failed vision screen to optometrist How? - know the resources and provide contact information Public Health Interventions - Case management optimize the use of resources through coordination of services Example - help teen Mom access and coordinate WIC, food stamps, well baby checks How? Encourage self-care and self-advocacy, monitoring outcomes Public Health Interventions - Delegated functions direct care that you delegate to another Example: RNs delegate specific functions to LPNs making home visits or in school settings Public Health Interventions - Health Teaching Communicating facts, ideas, skills to change knowledge, attitude, belief Public Health Interventions Public Health Interventions - Counseling develops a strong interpersonal relationship and/or emotional connection to increase capacity for self-care.
Population-focused public information or marketing campaign Example - State-wide campaign against smokeless tobacco on Old Barns in Southern, WV How? TV, radio, newspaper, social media Social Marketing Public Health Interventions - Policy development bringing health issues to the attention of policy makers, formulating a plan, and mobilizing resources. Results in laws, rules, regulations. Example: nurse requests that county School Board require 30 minutes of physical activity in all county schools How? Political activity, community organizing Public Health Interventions - Policy enforcement persuading others to comply with laws, rules, regulation Example: school nurses sending home information to parents about new immunization requirements How? Sharing information, reporting violations Community as a client Refers to a group or a population of people as the focus of nursing service A healthy community is more than the absence of disease, but includes things that promote the maintenance of a high quality of life and productivity by increasing healthy and decreasing disease and disparities in health and healthcare delivery Dimensions of the Community as Client Dimensions of the Community as - Client Healthy Community Perspective #
- Status/People
- Structure
- Process Dimensions of the Community as - Status/People Epidemiologic Data (morbidity and mortality, vital statistics, crime rates, suicide rates, injuries, alcohol and drug addiction) Demographic Data (characteristics of a population)
Dimensions of the Community as - Structure Availability, use, and quality of services and resources Dimensions of the Community as - Process Community's ability to function competently based on its strengths and limitations Dimensions of the Community as Client - Healthy Community Perspective # Physical location, Population, Social System Physical location climate, flora and fauna, boundaries, location of health services, geographic features & built enviro Population size, density, rate of growth or decline, demographics, cultural characteristics, social class and educational level (social determinants of health)& mobility Social Systems 10 major variables that interact and influence health of a community. See Figure 15- 6 health, family, economy, education, religion, welfare, politics, recreation law, communication Coronavirus- which location & population more likely to spread? Rural Ecuador Chinese airport Chinese airport The Healthiest Community What are 3 reasons that make this the healthiest community? Student Capstone Article: https://nursing.wvu.edu/news/story?headline=nursing-student-s-capstone- project-leads-to-playground-improvements-to-increase-childhood-exercise Spain one of the Healthiest Countries in the World
Key informants; demographic data; surveys Community assets assessments Strengths and capacities Community Assessment Methods Surveys Descriptive epidemiologic studies Geographic Information System Analysis Community Forums/Town Hall Meetings/Social Media Focus Groups Sources of Community Data Primary and secondary sources Key informants, client records International sources WHO, United Nation's Children's Fund National Sources UDHSS; CDC; US Bureau of the Census; NIH State and Local Sources Behavioral Health Surveillance System (BRFSS) WV Bureau of Public Health (state health department) Local: county extension office, service organizations Analysis Comparison of subjective and objective data Validation of data Use of computer programs or paper and pencil method if smaller communities Diagnosis Nursing diagnosis about a community's ineffective coping ability and potential for enhanced coping Should include strengths/weaknesses & possible solutions Create a Plan - Setting Priorities
- Assigning rank or importance to the identified needs to determine the order in which goals should be addressed
Create a Plan - Establishing goals and objectives
- Goals: broad statements of desired outcomes
- Objectives: specific statements of desired outcomes, phrased in behavioral terms that can be measured
- SMART Objectives:
- Specific
- Measurable
- Achievable
- Realistic
- Time Bound Implementation Putting the plan into "action" Who, what, why, when, where and how What activities or actions will the nurse be doing? Evaluation Measuring and judging the effectiveness of your goal/objectives Formative- process during the actual interventions Low turn out related to lunchtime at the senior center Summative-focuses on the outcome of the interventions The degree to which an outcome objective has been met Objectives Ch 15 Community as Client: Applying the Nursing Process Provide examples of the 17 different interventions of The Public Health Interventions Model Describe the characteristics of a healthy community Identify the dimensions of the community as client Explain the 5 types of community health needs assessments Compare and contrast five types of community assessment methods Identify key sources of community data Describe the stages of the health planning process
