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Community-Based Nursing: illness care of ind/families, manages acute and chronic conditions, family-centered, maintains appreciation for community values.
Community-oriented nursing: health care of community/populations & ind/families/groups, goal is to prevent disease, preserve, promote, restore health promotion and promoting quality of
life (goal is health promotion disease prevention for community)
Public Health Nursing: focus on the health care of communities and populations, prevent disease, preserve, promote, restore, and protect heath for the community and the population within
it. What society does to ensure that conditions exist in which people can be healthy. Ex. Working with community groups to create policies to improve environment. Works with community.
Ex. Nurse who spent the day attending meets of various health agencies
 ? to ask: Which group are at greatest risk for problems?
Public health core functions (3):
 Assessment: systematic data collection, monitoring health status, making that information available
 Policy development: efforts to develop policies to support the health of pop using a scientific knowledge base.
 Assurance: Making sure that essential community-oriented health services are available, providing essential personal health services for individuals as well as a competent PH
Primary prevention: vaccines, immunizations. Secondary prevention: medications, screenings Tertiary: rehab, treatment
PHN role: look at community/population as a whole, raise questions, work within community improve health status, provide health education, health and prevention focused, interventions
are community/pop centered (subset of oriented-look at epidemiology, statistics, assessment) (healthcare of communities/pop)
Ch. 2
Egyptians—constructed public drainage systems
Hebrew Mosaic Law (Old Testament)—describes maternal health, communicable disease control, protection of food and water
Elizabethan Poor Law – guaranteed medical care for poor, blind, and “lame” individuals, even those without family (similar to Medicaid today)
Ancient Greeks—linked health to the environment, exercise, diet and sanitation
Romans—emphasized regulation of medicine and punishment for negligence, provision of pure water, sewage systems
Florence Nightingale: identified need for nurses, origins of organized nursing, principles of nursing, improved soldier’s health by improving environmental and nursing care. Nursing should
promote health and prevent illness, emphasized proper nutrition, rest, sanitation, hygiene. Sanitation reform- she was concerned about the environmental determinants associated with
health and disease. Simple epidemiology- documented a decrease in mortality rates. Demonstrated the value of utilizing statistics to describe population factors. Made first trained nursing
Visiting nursing establishment: took care of several families in one day, promoted prevention campaign, worked with physicians, gave treatments, kept temp/pulse records, emphasized
education of family members. (1887-new York city), (1883-chigcago), (1886- philly boston)
Lilian Wald: saw how the poor did not have same access to health care as wealthy. Established Henry st settlement for visiting nurses service for the poor on lower east side. Providing home
nurse care on a fee-for-service basis, establishing an effective cost-accounting system for VN, using advertisement in newspaper and on radio, reducing mortality from infectious diseases.
School based nursing: suggested there be a nurse in schools to address large #’s of kids absent from illness- was successful and had the first public school nurse hired (Lina Rogers), she took
care of so many children she needed more help, made home visit to teach parents, documented all nursing interventions and provided records of improvements. After 1 year, first fleet of 12
school nurses were hired.
Metropolitan Life Insurance company: PHN decreased policyholders death and lowered costs for insurance companies.
20th century nurses: were enrolled in diploma schools which were focused more so on hospitalized clients
Nursing process in PH
- Data collection: assessment for community-oriented nursing?
o The goal is to acquire usable information about the community and its health. Data collection should provide information about community health problems and
community abilities.
o Interviews, Surveys, Direct observations, Focus groups- can give incite to values, beliefs, and needs of the community
o (how welcome you are in that community is key—participate in community evens, meet with higher ups, identify whats important to them
- Data gathering: look at existing data and analyzing
o Identify the problem and analyze data collected.
o obtaining existing, readily available data, such as age and gender of residents. Vital statistics are a great source of data to assess a community’s health. (other good
sources of data include demographics, education and school statistics, and environmental factors)
- Data generation is the process of developing data that do not already exist, such as values, norms, leadership, and influence structures.
 Diagnosis: Use the data to solidify the problem and who is involved in that community, how much of a priority it is
 Planning: goals and measurable objectives are identified, goal oriented activities
- Continue to analyze, establish priorities, identifying goals/objectives
 Implementation: how you’re going to get there
 Evaluation: are goals/objectives met, revamp if necessary
Community readiness to change: high participation by community, socioeconomic status
Community: social group with common goals, characteristics, interests within the same geographic area.
Community priority: what the community needs are, what’s of most importance/ of concern to them
Structure: services and resources available in the community (treatment, service use patterns, provider client ratios
Process: level of intervention of PHN in the community-focus on health promotion
Status: health risk profiles/vital statistics
Stages in assessing client need:
 Preactive – projecting a future need: need for a specific program in the future
 Reactive – defining the problem based on past needs identified by client or agency
 Inactive – defining the problem based on existing health status of the population served
 Interactive – describing the problem using past and present data to project future population needs
Assessing community health: vital statistics, demographic data, environmental factors
Ch. 16
Program Management: (APIE)
 Major sources of information for program eval: program clients, records, community indexes
 MAPP: organizing community members, generating common beliefs, values, framework development, needs assessments, community strengths
 Evaluation:
- Formative evaluation -purpose is assessing whether objectives are met or planned activities are completed; begins with an assessment of the need for a program and is
ongoing as the program is implemented
- Summative evaluation -assesses program outcomes or as a follow up of the results of a program’s activities and usually occurs at a specified time-end of program or after 1
year, 5 years etc
 Goal: resources are efficient, will work, are accepted by that community, equal and fair
 Strategic planning: matching of clients’ needs to providers and their resources

Ch. 5
Lasting resilience (longing impact): ESL programs are lasting because they are learning the language (QUESTION)
 Immigrants:
o Assess your own bias (priority) when working with, ask how you can help, don’t try to change their view
 Refuges:
o Consider they are Fleeing for some reason
o Leave everything behind due to being tortured, loved one killed
o Financially insecure, insurance issues due to language barriers
 Communication:
o Nonverbal communication
 Cultural competence: nurses should alter nonverbal behaviors to match the client

Environmental control:
 Hispanic/AA: don’t want treatment for cancer because it wont matter what I do
 NA: illness is symptom of bein gout of balance with nature
 AA, Asian, Hispanic, NA: mongoloian spots do not mean bruising cannot assume
Food preferences:

Cultural competence: culturally congruent behavior, practice attitudes, policies that allow to work effectively in cross-cultural situations
 Avoid seeing all individuals as alike.
 Maintain a broad, open attitude
 Promote mutual respect for differences
 Again be culturally aware assess your biases
 This is the first step to developing cultural competence
 Cultural preservations: combining
Cultural awareness requires self-examination and an in-depth exploration of one’s own beliefs and values as they influence behavior. Cultural awareness is the first element in the model of
cultural competence. Following the development of cultural awareness, the next step is cultural knowledge in which information about organizational elements of diverse cultures and ethic
groups is collected. The next stage of the model, cultural skill, occurs with the effective integration of cultural awareness and cultural knowledge to obtain relevant cultural data and meet the
needs of culturally diverse clients. The fourth construct essential to this model is cultural encounter which is the process that permits nurses to seek opportunities to engage in cross-cultural
interactions with clients of diverse cultures to modify existing beliefs about a speciifc cultural group. Cultural repatterning means that the nurse works with clients to help them reorder, change,
or modify their cultural practices when the practice is harmful to them
OPEN ENDED QUESTIONS: where is your fam from, who lives in the hoe, do you practice any religion and if it impacts your health, ell me about foods you prefere, who makes the decision in
the household, what types of activities to stay healthy
Ch. 6 Ethics in public and community nursing practice:
 Role: first contact for patients and families in the community, establish trust among community groups/law markers
 Assess own beliefs
 Patient/family wishes
 Community values
 Moral distress: knowing the morally right course of action but not being able to act accordingly
 Major catastrophe
 Caring: most important goal in nursing today
Principlism: Relies on ethical principles of autonomy, Nonmaleficence, beneficence and justice
 Respecting autonomy means to respect a patient’s right and ability to make their own business: - Patient autonomy comes first (even if they decide to withdraw care and you don’t
 Nonmaleficence is do no harm
 Beneficence is doing good
If we focus on individuals needs, society as a whole is ignored
Ethics/Public health policies similar: they aim to improve communities as a whole---do good
Healthy People 2020: primary prevention, prevent not cure
 To eliminate preventable disease, disability injury, an premature death
 To achieve health equity, eliminate disparities, and improve the health of all groups
 To create social and physical environments that promote good health for all
 To promote healthy development and healthy behaviors across every stage of life
Determinants of Health
 Policy making: taxes on tobacco products- limits the number of people who use them
 Social factors: Exposure to trash, lead, housing (physical)
 Health services: barriers such as access, cost, insurance
 Individual behavior: diet, exercise
 Biology and genetics: sickle cell, age, sex, HIV status, inherited conditions
Framework for implementing HP 2020 for PHN
◦ Mobilize partners
◦ Assess the needs of your community
◦ Plan interventions
◦ Implement interventions, track changes
Singulair: cant take with aspirin, take daily pill Narcan admin: can be IM, IV, nasal. Monitor RR, LOC. Can repeat dose in 2-3 min if no change in LOC, effects last for about 45 min