1.  describe, clarify and guide CHN practice

2.  provides rationale for community-oriented care

• focuses on preventive care for populations
• theory based on improving environment conditions to improve health

age

gender

developmental status

health status

health care systems

socio-cultural

spiritual orientation

family system

patterns of living

education

income/employment

housing

Zoning-city/urban/rural/commercial

Mobility

Growth/decline

example of Air requisite for community health according to orem

1. individual

2. family

3.  community

1.  COPD related to smoking prevalence

2.  Decrease second hand smoke in homes and public buildings

3.Ozone days,  policy for smoking in public buildings and establishments

examples of Water according to Orem for commumity

1.  Individual

2. family

3.  community

1.  test water for contamination

2. none listed

3.  instruct importance of testing to prevent enteric diseases related to water supply

examples of prevention of hazards for community health for the

1. individual

2.family

3. community

1.  instruct to decrease alcohol use among young and middle age adults

2.  instruct to decrease alcohol among family members

3.   develop and offer programs and drinking and driving, MADD organizations

thinking upstream vs thinking downstream

which is proactive, vs. reactive

upstream is proactive

downstream is reactive

• looks at mainly individuals r/t health and illness
• emphasizes idividual behavioral responses to illness/lifestyle
• interventions focused on modify behavior to change perceptions of belief systems 

• looks at interfamily and intercommunity theme in health/illness
• looks at population factors
• empasizes social, economic, and environmental issues
• modifying social and environmental variables
• being a social and political activist 

the community population

the "who"

the people/population

size,

 density,

 composition(age, gender, family),

 growth or decline,

culture/race/ethnicity

social class/eduacation level of HOH

mobility

health/morbidity/mortality

territorial(where and when)

geopolitical

community of interest

community of solution

relational bonds (phenomenological)

the how and why

community cohesion

• "collaborate effectively in IDing community needs/problems"
• achieve working consensus on goals and objectives
• agree on implementation of goals
• collaborate on required action

comprehensive

problem-oriented

familiarization

subsystem assessment

epidemiological

community assets-strengths and capacities of a community

involves linking of

specific skills of interest

local associations

local institutions

direct

winshield survey

participant observation

key informant interviews

community forums/focus groups

indirect

• generalized from community/aggregate assessment
• intervention directed to total community/aggregate
• total community/aggregate is beneficiary

ID health risks

ID factors and health indicators associated with risks

Validate existing health problems

• inaccessible and unavailable services
• mortality and morbidity rates
• communicalbe disease rates
• specific populations at risk
• health promotion needs for populations
• community dysfunction
• environmental hazards 

risk of :

among:

related to:

as evidence:

risk of:  id's a specific problem/health risk

among:  a specific community/client group

related to : characteristics of community and environment that places group at risk

as evidence by:  signs/symptoms supporting label

subpopulation

church, schools, and fire districts

towns

health and other vital statistics

1. a needs assessment

2. action oriented community diagnosis

3.  from target population to community

4.  gaining entry into a community

5.  id'ing community informants and felt needs

6.  analyzing needs with a community

7.  presenting findings to a community

communication skills of lay persons and professionals

lay and professional knowledge of health topics

culture

demands of the healthcare and public health systems

demands of the situation/context

• a community's literacy level is important factor in health program planning
• health literacy affects a person's ability to
• navigate the healthcare system
• sare personal info
• engage in self-care/chronic disease mgt.
• understand mathematical concepts(ex. probability and risk)
• community nurses have the ability/opportunity to ID areas patients and communities may be struggling in, eval. the problem, and implement solutions/interventions 

vision statement of health literacy includes 3 main points, that a health literate society is one that

1.  provides everyone with access to accurate and actionalble health information

2.  delivers person centered health information and services

3.  supports lifelong learning  and skills to promote good health

health education:  focuses on health promotion and disease prevention, educating and empowering people, to avoid disease, make lifestyle changes, improve health for themselves

patient/client education:  a series of planned teaching-learning activities designed for individuals, families, and groups who have a ID'd alternative health status

behavior motivated to

reduce threat of disease

detect early

maintain functioning within the illness

(look at a risk population, prevent disease)

behavior-achieving a greater level of health

self care

ex. diet, exercise

what are three models tat relate to the health and health education of the individual and the aggregate?

2 for community?

1. orem

2. health belief model

3. Pender's Health promotion Model

community

1.  PRECEDE model

2. Primary Health care model

discuss the health belief model>

value?

goal?

focus?

it describes the impact of individual's perceptions on preventive health behaviors actions

value- health (absence of disease)

goal- avoidance of disease

focus- increase "threat"

1. personal susceptibility to a disease
2. perceived severity of a disease
3. perceived benefits of preventative behavior
4. perceived barriers to taking action
5. cues to encourage taking action
6. self-efficacy-the ability to take action to achieve te desired outcome. 

individual perceptions

modifying factors of action

likelihood

explains the likelihood that healthy lifestyle patterns or health promoting behaviors will occur

belief- people change behavior to feel better physically, psychologically, socially and spiritually (not to just avoid disease)

increased emphasis on self-efficacy

adds-perceived control and perceived importance of health

which model pender's health  protective model is directed toward health protecting behavior?

health promoting?

health protecting- HBM

health promotion-HP

pender health promotion model

precede-needs assessment

proceed- implementation

focuses heavily on the assessment and ID of strengths and weaknesses for planning and evaluating community health education

define the parts of the community model - precede

Predisposing

Reinforcing and

Enabling

Causes in

Educational

Diagnosis and

Evaluation

1. health is multi-factoral (environmental, social, etc)

2.  health education programs must be multidiementional

outcomes oriented! toward the community

domains of learning

cognitive-

affective-

psychomotor learning-

cognitive-knowing (facts and concepts)

affective-judging and deciding

proper attitudes is necessary for lifestyle changes

psychomotor-action or skill

performing or doing

in the cognitive domain (the thinking process)

what is blooms taxonomy of learning

6. evaluation

5.  syntesis (integrates)

4.  analysis(examines)

3.  application(uses learning)

2.  comprehension(understands)

1.  knowledge(recalls knows)

blooms taxonomy of learning domain-affective (emotions, feelings or attitudes)

5.  internalizing(adoption)

4.  conceptualization(integrates)

3.  valuing(appreciates)

2.  responding(reacts)

1.  receiving(listening)

blooms taxonomy of learning domain-psychomotor domain

demonstration and performance skills

3.  physically intellectually and emotionally capable of skill

2.  sensory image to perform skill trough senses

1.  practice and master skill

-the assessment is completed

-data as been analyzed

-problems have been ID'd and prioritized for the population at risk

-and a desire to change exists

1. is it realistic

2.  is it attainable (literature to support your outcomes)

3.  measurable

4.  is it set within a given timeframe

5.  is it acceptible to the population

statements which indicate specific way to accomplishing goals

will help you measure progress toward the goals

3 specific things

1. what will be different

2.  by when?

3.  how will the results be measured?

in evaluation when who evaluates the process?

the outcome?

process-teacher

outcome-learner

• provides feedback to determine a need for modification
• is ongoing
• provides direction for change in goals and interventions
• this monitoring is periodic

• it is a final goal
• addresses overall effectiveness and goal attainment
• completed at end of program
• provides data if objectives were met or not met

formerly known as the public health intervention model (PHI) model

developed ad model for population based public health nursing practice

describe the full scope of PH practice

explain how their practice contributes to the improvement of population health

• population/people(size, density, composition, age/gender, family)
• location,, physical environment(boundaries ocation of health services, geographic, housing, climate, flora/fauna, human-made environment
• territorial bonds (whena nd where)-geopolitical, community of interest, community of solution
• relational bond(phenomenological)-interest orientation, feeling
• social system/psycosocial/function-family, economic, educational, religious, welfare, political, recreational, legal, communication

sense of community cohesion

• collaborate effectively in IDing community needs and problems
• achieve working consesnus on goals and objectives
• agree on implementation of goals
• collaborate on required action

crime, educational system, economy, environmental factors, housing, transportation, leisure activities, taxes

direct observation

1. winshield survey
2. participant observation
3. key informant interviews
4. community forums/focus groups

indirect observations

1. existing data sources
2. surveys

ID health risk

ID factors and health indicators associated with risk

validate existing health problems

inaccessible and unavailable services

mortality and morbidity rates

communicable disease rates

specific populations at risk

health promotion needs for populations

community dysfunction

environmetal hazards (MUEKE)

behavior, achieving a greater level of health, self care

outcomes of health promotion, outcome is self responsibility for health, change patterns of behavior to promote health rather than to avoid illness, focus on persons and populations as a whole

school based programs

worksite programs

church based programs

hospital based programs

neighborhood programs

community wide programs

what do you expect to occur as a result of your program?

is it realistic?

attainable (literature to support?)

measurable?

set within a given time frame?
is it acceptable for the population?

individual and families within a population

knowledge, attitudes, beliefs, practices, and behaviors

alone or part of a family , class or group

all of the following are biological factors that have been hypothesized as contributing to the development of mental illness except

a.  genetics

b.  Hormones

c.  neurotoransmitters

d.  structural brain anomalies

which of the following is not a risk factor for intimate partner violence?

a.  female 24 yrs of age

b.  middle income family

c.  woman who were abused as children

d.  alcoholic partner