Assessment

Systemic data collection on the health of the population, monitoring the population’s health status and making information available about the health of the community

Policy Development

Leadership 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 the needed health services are available including the ability to respond to critical situations and monitoring the quality of health services

Community-based nursing practice

Focuses on illness

§  Manages acute and chronic conditions

§  Focuses on “illness care” of individuals and families across the lifespan 

§  “Setting-specific” practice (care is provided where people live, work and attend school)

Community-Oriented Nursing Practice

Focuses on healthcare

§  Prevents disease and disability

§  Promotes, protects and preserves health

§  Focuses on health care of individuals, families and groups in the community 

§  “Community diagnosis” (health surveillance, monitoring and evaluation of community population)

Community Health Nursing Practice

focuses on individuals, groups and families within a community

Public Health Nursing Practice

focuses on the community as a whole

Individual/Family Care

changes knowledge, attitudes, beliefs, practices, and behaviors of individuals. This practice level is directed at 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.

Community Level of Care

  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 of Care

 changes organizations, policies, laws, and power structures. The focus is not directly on individuals and communities but on the systems that impact health. Changing systems is often a more effective and long-lasting way to impact population health than requiring change from every single individual in a community.

Community

people and the relationships that emerge among them as they develop and use in common some agencies and institutions and share a physical environment

Population 

a collection of people who share one or more personal or environmental characteristics 

Population-at-risk

A population with a common identified risk factor or risk-exposure that poses a threat to health (ex: women with breast cancer)

Population-of-interest

A population that is essentially healthy but who could improve factors that promote or protect health (ex: college students)

Determinents of Health

the conditions in which people are born, grow, live, work and age which shape their health status

Three Levels of Prevention

Primary: Keeps problems from occurring in the first place by targeting essentially well populations and promoting health (ex: education, sunscreen, vaccines)

Secondary: Early detection and treatment of problems targeting populations that have risk factors in common and keeping problems from causing serious effects or from affecting others in the population (ex: TB  test, screening, mammogram)

 Tertiary: Keeps existing problems from getting worse and prevents complications targeting populations who have experienced disease or injury and restoring individuals to their optimal level of functioning (ex: treating a disease)

Primary Care

The providing of integrated, accessible health care services by clinicians who are accountable for addressing a large majority of personal health care needs, developing a sustained partnership with patients, and practicing in the context of family and community

§  Focus: individuals 

§  Emphasis: cure

Primary Health Care

A combination of primary care and public health care made universally accessibly to individuals and families in the community, with their full participation and provided at a cost that the community and county can afford

§  Focus: community 

§  Emphasis: prevention

Pink Wedge of Intervention Wheel

• Surveillance
• Disease & Other Health Event Investigation
• Outreach
• Screening

Green Wedge

• Referral & Follow-up
• Case Management
• Delegated Functions

Blue Wedge of Intervention Wheel

• Health Teaching
• Counseling
• Consultation

Red Wedge of Intervention Wheel

• Collaboration
• Coalition Building
• Community Organizing

Surveillance

describes and monitors health events through ongoing and systematic collection, analysis & interpretation of health data for the purpose of planning, implementing and evaluating public health interventions

Disease & Other Health Event Investigation

systematically gathers and analyzes data regarding threats to the health of populations and ascertains the source of the threat, identifies cases and others at risk, and determines control measures

Outreach

Locates populations-of-interest or populations-at-risk and provides information about the nature of the concern, what can be done about it and how services can be obtained

Screening

identifies individuals with unrecognized health risk factors or asymptomatic disease conditions in populations

Referral & Follow-up

assists individuals, families, groups, organizations, and communities to utilize necessary resources to prevent or resolve problems or concerns. 

Case Management

optimizes self-care capabilities of individuals and families and the capacity of systems and communities to coordinate and provide services.

Delegated Functions

are direct care tasks a registered professional nurse carries out under the authority of a health care practitioner, as allowed by law. Delegated functions also include any direct care tasks a registered professional nurse entrusts to other appropriate personnel to perform. Must ensure the 5 R’s:

 -   Right task; Right circumstance; Right person; Right direction; Right supervision

Health Teaching

communicates facts, ideas, and skills that change knowledge, attitudes, values, beliefs, behaviors, practices, and skills of individuals, families, systems and/or communities

Counseling

establishes an interpersonal relationship with a community, system, family or individual intended to increase or enhance their self-caring and coping. Counseling engages the community, system, family or individual at an emotional level

Consultation

seeks information and generates optional solutions to perceived problems or issues through interactive problem-solving with a community, system, family or individual. The community, system, family or individual selects and acts on the option best meeting the circumstances

Collaboration

commits two or more persons or organizations to achieving a common goal through enhancing the capacity of one or more of them to promote and protect health. Differs from coalition building and community organizing in two ways:

-   Collaboration requires a willingness to enhance the capacity of some of the collaborative’s member over and above one’s own interests in order to achieve the desired collective goals

-   Occurs at the individual/family level

Coalition Building

         promotes and develops alliances among organizations or constituencies for a common purpose. It builds linkages, solves problems, and/or enhances local leadership to address health concerns

-   does not require enhancing the capacity of other organizations or constituencies within the coalition

-   primarily a systems level of practice but may be a community level as well

Community Organizing

helps community groups identify common problems or goals, mobilize resources, and develop and implement strategies for reaching the goals they collectively have set.

Advocacy

pleads someone’s cause or acts on someone’s behalf with a focus on developing the community, system, individual, or family’s capacity to plead their own cause or act on their own behalf

Social Marketing

utilizes commercial marketing principles and technologies for programs designed to influence the knowledge, attitudes, values, beliefs, behaviors, and practices of the population-of-interest. It is most often used at the community level and utilizes the 4 P’s (product, price, place & promotion)

Policy Development & Enforcement

places health issues on decision-makers’ agendas, acquires a plan of resolution, and determines needed resources. Policy development results in laws, rules, and regulations, ordinances and policies

Domains of Learning

• Cognitive
• Affective
• Psychomotor

Cognitive Domain of Learning

"Blooms Taxonomy"

1. Knowledge: define, describe, identify, label
2. Comprehension: classify, explain, paraphrase
3. Application: act, administer, apply, collect
4. Analysis: contrast, correlate, debate, distinguish
5. Synthesis: adapt, anticipate, collaborate, compose
6. Evaluation: appraise, conclude, critique, support

Affective Domain of Learning

is difficult to measure and involves learning through emotion, feeling or afect (deals with changes in interest, attitudes & values)

Psychomotor Domain of Learning

 Visible, demonstratable performance skills that require some kind of neuromuscular coodrination. For psychomotor learning to occur, 3 conditions have to be met:

1. Learners must be capable of skill
2. Learners must have a sensory image of how to perform skill
3. Learners must practice the skill

Types of Screening

• Mass
• Targeted
• Periodic

Mass Screening

a process to screen the general population for a single risk–such as cholesterol screening in a shopping mall–or for multiple health risks–such as health fairs at work sites or health appraisal surveys at county fairs (community level) 

Targeted Screening

a process to promote screening to a discrete sub-group within the population–such as those at risk for HIV infection (individual/family level)

Periodic Screening

a process to screen a discrete, but well, sub-group of the population on a regular basis, over time, for predictable risks or problems; examples include breast and cervical cancer screening among age-appropriate women, well-child screening, and the follow-along associated with early childhood development programs (individual/family level)

2 Criteria for effective screening program

Validity

&

Reliability

Reliability

the precision, stability, agreement, or replicability of a measuring instrument when repeatedly used; an indication of consistency from time to time or from person to person

Validity

the accuracy of a test or measurement; how closely it measures what it claims to measure. In a screening test, validity is assessed in terms of the probability of correctly classifying an individual with regard to the disease or outcome of interest, usually in terms of sensitivity and specificity. 

Sensitivity

how accurately the test identifies those individuals with the risk condition or disease. Identifies the proportion of persons with the problem whom the test accurately identifies as positive (true-positives) 

Specificity

how accurately the test identifies those people without the problem. Identifies the proportion of people without the problem who the test accurately identifies as negatives (true-negatives)

Types of Surveillance Systems

Active or Passive

Ongoing or Time-Limited

Formal or Informal

Active Surveillance Systems

Systems in which the health jurisdiction regularly contacts reporting sources to elicit reports, including negative reports (that is, no cases). Active systems collect more complete data but are labor-intensive and, therefore, expensive to implement. They are usually only indicated in unusual or unpredictable circumstances, such as evidence of a new or rarely seen pathogen

Passive Surveillance Systems

Systems in which the health jurisdiction (that is, federal, state, or local health departments) receive reports of disease or health events from physicians or other individuals or institutions often mandated by state law. States’ reportable disease systems are examples. Most surveillance systems are passive.

Ongoing Surveillance Systems

Systematic collection of data over time on selected diseases or health events that impact the health of the population.

Time-Limited Surveillance Systems

Systematic collection of data on specific problems or concerns for a specific time period. This may identify all cases in order to assess the level of risk or threat or, when resources are limited, estimate the size through sampling. Most active surveillance systems are limited systems.

Formal Surveillance Systems

Systems with multiple reporters, frequently mandated by law and most often at the state or federal levels of government. 

Informal Surveillance Systems

Informal process of systematic data collection often in conjunction with case-finding. . Implementing the surveillance intervention can be as simple as regularly reviewing the case records in your drawer or laptop to determine what similarities they might have. The PHN is a trained observer, the “eyes and ears on the community,” always looking for events, changes, and trends in the community that may impact population health status.

True Causes

Represents an actual increase in cases of an health related event

Artifacts

Changes that are due to other than in increase in cases

2 Types of Community Organizing

1. Bottom-up organizing ("grass roots"/"citizen initiated" organization)
2. Top-down organizing ("outside-in" organization)

Stakeholders

If a problem exists in a community, there are probably some people who benefit from its existence and who may work toward preventing a successful solution to the problem. These are the stakeholders.

Gatekeepers

The individuals who control both formally and informally the political climate of the community and/or a well-respected organization or institution that is already established within the community 

Types of Media

• Daily newspapers
• Weekly newspapers
• Radio
• Television

Methods to work with the media

• News conference
• Public service announcement (PSA)
• Editorial board
• News release
• Interview

3 Core Functions

1. Assurance
2. Assessment
3. Policy Development

Key Nursing Modes

• Community-Oriented Nursing Practice
• Community-Based Nursing Practice
• Community Health Nursing Practice
• Public Health Nursing Practice