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119 Cards in this Set

  • Front
  • Back
what is a community?
Group of people who share something in common and interact with one another who may exhibit a commitment with one another and may share a geographic boundary

ie: church parish, NYU students, city of Yonkers
What is a population?
Group of people who have at least one thing in common and who may or may not interact with one another

ie: long distance truck drivers, nurses who do night shift
what is Community-focused Nursing
A systematic process of delivering nursing care to improve the health of an entire community

what is Community-based Nursing
Nursing care provided outside of an acute care setting to individuals and families which contributes to the health of the community

what is Population-focused Care
Interventions aimed at health promotion and disease prevention that shape a community’s overall health status
what is Public Health Nursing
Practice of promoting and protecting the health of populations using knowledge from nursing, social and public health sciences.

-It is population-focused, with the goals of promoting health and preventing disease and disability for all people through the creation of conditions in which people can be healthy.
what is managed care aka chronic care
nurse is in charge of making sure that a particular group of people sty out of the hospital

-this involves telehealth

-this is happening so we can prevent a problem that nurses would traditionally see at the hospital (goal is to save $, lives)
(7 things)
1) Provider control

2)Predictable routine

3) Maintenance of hospital policy

4) Resource availability

5) Collegial collaboration and consultation

6) Controlled patient compliance

7) Standardization of care
what is Community-based NURSING
1) Familiar and comfortable environment for patient

2) Routine less determined by the nurse or health professional

3) Diverse resources (ie; church volunteers, grocery delivers)

4) Autonomy and choice in health decisions for the pt.

-community health nursing req. flexibility & patience;

-its not regimented like acute care nursing
what is health?
client will dictate description of health
what is Professional Health Promotion
the organized actions or efforts that enhance support or promote the well-being/health of individuals, families, groups, communities or societies

ie: school nurses, health fairs, clinics w/ flu vaccines, free dental screening
What are the 3 levels of Prevention
1) Primary

2) Secondary

3) Tertiary
what is Primary Prevention
Reduction of risk factors before occurrence of disease condition or injury
what is Secondary Prevention
Early detection of the potential for disease or disability or, the existence of disease while asymptomatic

ie: nurse monitoring telehealth machine would be in secondary/tertiary prevention
what is Tertiary Prevention
Treatment of an existing or symptomatic disease to prevent or delay progress
what is Health Promotion
relates to the events or activities that result in wellness

-is relative to where the person is at
what is Wellness
Integrated method of functioning which is oriented towards maximizing the potential of which the individual is capable of
what is UPSTREAM thinking
why treat people...w/o changing what makes them sick?

-find out why bodies are flowing down the river, go upstream to try to stem it
who is Lillian wald
-founded community/public health nursing

-also started Visiting Nurse Services

-focused on home healthcare & hygiene among LES tenements

-founded Henry Street Settlemtn
what are the 8 attributes of a community health nurse?
1) Population focused

2) Autonomy

3) Continuity

4) Collaboration

5) Interactivity

6) Public Accountability

7) Sphere of Intimacy

8) Health orientation
what is Population focused

(attribute of community health nurse)
Emphasis is on health of population groups rather than individuals or families.
what is Autonomy

(attribute of community health nurse)
nurse is independent; not as much structure as is the case w/ a hospital
what is Continuity

(attribute of community health nurse)
Provision of care on a continuing, comprehensive basis rather than a short-term, episodic basis.
what is Collaboration

(attribute of community health nurse)
Interaction between nurse and client as equals; greater opportunity for collaboration with other segments of society. (its a negotiation)
what is Interactivity

(attribute of community health nurse)
Greater awareness of interaction of a variety of factors with health.
what is Public Accountability

(attribute of community health nurse)
Accountability to society for the health off the general population.
what is Sphere of Intimacy

(attribute of community health nurse)
– Greater awareness of the reality of client lives and situations than may be true in other areas of nursing.

ie: u see roaches in apt
what is Health Orientation

(attribute of community health nurse)
Emphasis on health promotion and disease prevention rather than the cure of illness.
what are some Community Health nursing roles (titles)
Care giver



Referral resource

Role model


Primary care provider

Case manager




Discharge planner

Case finder


Change agent

what are the types of Community Health Jobs
Public Health Nurse

Home Health/Visiting Nurse

Hospice Nurse

School Nurse

Occupational Health Nurse

Parish Nurse

Advanced Practice Nursing (PNP, FNP, CNM, etc
5 steps of Nursing Process in Community Nursing (ADPIE)
1) Assessment

2) Diagnosis

3) Planning

4) Implementation

5) Evaluation
What is Assessment in community nursing
looking at the characteristics in a population & we need to compare it to another community

(ie: demographics, age group, health problems, economic status)
what is Diagnosis in community nursing
vs. acute care setting
risk of, among, related to
what is planning in community nursing
create an intervention that the community agrees wit/after you have assessed

-planned intervention has to be achievable/measurable
6 steps for Using the nursing process for the community
1) Conducting a community assessment

2) collecting data

3) community diagnosis

4) Planning & Prioritization Phase

5) Implementation Phase

6) Evaluation Phase
Conducting a community assessment means
-population assessment

-primary informants aka key informants

-gaining entry into the community -->who do u talk to 1st to learn about the community (ie: mayor, relg leaders)
what is Kauffman's 5 Phases of gaining entry into the communtiy
1) Impressing

2) Behaving

3) Swapping

4) Belonging

5) Chilling out
-one of Kauffman's 5 phases of gaining entry into the community

- you're new & being judged by community

-wariness from the community

-u should be neutral, an observer & a resource to the community
-one of Kauffman's 5 phases of gaining entry into a community

-as relationship develops, myths about you & your own myths about the population begin to erode (try to learn the language)
-one of Kauffman's 5 phases of gaining entry into the community

-they are giving things to you & u are sharing things w/ them
-one of Kauffman phases of gaining entry into the community

-people are starting to share things w/ u that they wouldn't share w/ an outsider

-"the hidden becomes exposed"
Chilling out
-one of 5 Kauffman phases of gaining entry into a community

-true partnership & future planning
Collecting data--7 methods
(pt of nursing process for the community)
1) Informant interviews

2) Observation

3) Secondary analysis of existing data

4) Constructed surveys

5) Focus groups

6) Community forums

7) Windshield surveys
Community Diagnosis (pt of nursing process for the community)
Risk of (specific problem or health risk )

Among (specific group or population affected by the problem/risk)

Related to (strengths and weaknesses in the community that influence the specific problem or health risk in the community)
Planning & Prioritization phase (pt of nursing process for the community)
Priorities established--> the community determines what the priority is/what they want changed

Goals and objectives identified

Community focused interventions--> make sure u have community buy in
Implementation phase (pt of nursing process for the community)
consists of Action phase:

Role of community health nurse (should avoid paternalism--> telling community what to do); role is to help educ, implement plan

Social change and community action:
Lay advisors
Focus groups
Policy legislation
Mass media
Media advocacy
2 types of evaluation? (pt of nursing process for the community)
1) Formative

2) Summative
what is Formative Evaluation
something you do during the process

-"evaluation in process"

ie: @ bedside doing assessment & pt says it hurts so you stop & do something else
what is Summative evaluation
-done @ the end

-you've looked at assessment, plan & intervention & now u grade yourself at the end
what are the 2 types of community assessment frameworks
1) WHO--> community empowerment

2) Community as Partner Model:

Community core
Eight interacting community subsystems
Community stressors/boundaries
Normal level of defense
Flexible line of defense
Lines of resistance
what is health education
Any combination of planned learning experiences based on sound theories that provide individuals, groups, and communities the opportunity to acquire the information and skills needed to make quality health decisions

- Remember that information alone does not change behavior
what are Goals for health education
To help individuals, groups and communities achieve, through their own actions and initiative, optimal states of health

Should facilitate voluntary actions to promote health



Example of Primary Prevention r/t Community Health education
Education at Health Fairs such as Immunizations for children and adults
example of Secondary Prevention r/t Community Health education
Education at Health Fairs to include early diagnosis of diabetes/provide screenings before disability occurs
example of Tertiary Prevention r/t Community Health education
Education in Rehab Centers such as helping clients post CVA maximize their functioning
what are the 9 ways to facilitate learning
*Use methods to stimulate senses

*Use active learning

*Establish a comfortable environment

*Assess readiness of learner

*Make information relevant

*Use repetition

*Make learning positive

*Proceed from simple to complex

*Generalize and pace appropriately
what are the 4 behavioral learning theories
1) health belief model

2) harm reduction model (controversial)

3) goal-setting therapy

4) theory of reasoned action
what is health belief model (behavioral learning theory)
Perceived susceptibility, severity, benefits and barriers. Also includes self-efficacy

ie: I’m at risk for colon cancer and I will follow up with annual FOB and screening per HCP, even though its unpleasant
what is Harm reduction model
Based on understanding that accurate information can help people make responsible decisions/focus is on education and not aimed at complete abstinence.

ie: I know my risk for colon cancer , but I love my beef.

ie: I’ll decrease it to once a week if my wife helps me

-argument against this theory is that you are encouraging the bad behavior
what is goal-setting theory (behavioral learning theory)
ie: My goal is to lose 12 lbs over the next 6 months. I know that 2 lbs a month is realistic for me.
what is theory of reasoned action
ie: I will sign up for Weight Watchers because they helped me years ago, and I can go with my friend
what is the Transtheortical Model ?
- is a change process model/most common

-Provides a framework for exploring if a client is ready to make changes in behavior

- Useful in persons who are engaged in “risky behavior”

- Movement through stages may be sequential or not, i.e. May move back and forth through the stages
what are the 6 stages of change in the Transtheortical Model
1) Precontemplation

2) Contemplation

3) Preparation

4) Action

5) Maintenance

6) Termination
Precontemplation (transtheortical model)
I smoke/I like it/dont care if I die

-person not gonna change
Contemplation (transtheortical model)
smoking might be a problem, I might get COPD/CA/, I get that it will cause that
Preparation (transtheortical model)
maybe i should quit, maybe try 1 pack to 1/2 pack a day

--preparing to quit/thinking about it
ACTION (transtheortical model)
I quit. Im gonna have withdrawal but Im quitting anyway
Maintenance (transtheortical model)
I must not go back again/ I need to stop going to these bars cuz dont want to be tempted
Termination (transtheortical model)
I used to be a smoker but the smell makes me gag/Im allergic to smoke now
Driving Forces & Restraining Forces
If you want to change the present stage (ie: smoking) you must increase the driving forces (ie: teach pt. how much cigs cost) & decrease the restraining forces (ie: making it easier to quit smoking by avoiding the bar)
6 Principles that guide the educator
1) Message

2) Format--has to be something the client will appreciate

3) Environment

4) Experience-client should practice how to draw insulin

5) Participation

6) Evaluation-did u learn anything
3 Domains of the Nature of Learning
1) Cognitive domain

2) Affective domain

3) Psychomotor domain
what is Cognitive domain
includes memory, recognition, understanding, application and problem solving

-where much of your education happens
what is Affective domain
includes attitudes and values (what people think, feel and value)
what is Psychomotor domain
includes performance of skills that require some degree of neuromuscular coordination and emphasize motor skills
what is health literacy
The ability to read, understand, and act on health care information

-seen as the 6th vital sign
What are the Consequences of low functional health literacy
1) Less likely to Understand written and oral information given by the health care provider

2) Less likely to Act upon necessary procedures and directions such as medications and appointment schedules

3) Less likely to Be able to navigate the health care delivery system to obtain needed services
what are the strategies to assist low-literate health care consumers
HCPs can create a ‘Shame Free” environment

Provide surrogate readers to decipher information

Clinic staff can tell client what is needed prior to an appointment (medication list, insurance card etc)

Tailor medication schedules to fit daily routine, color coding medications etc

Teach-back method (ie. Can you tell me in your own words?)

If low health literacy is suspected, give individual an out such as “A lot of people have trouble with this material.”

Use common words, not medical jargon

Use tools designed for low literacy levels

Limit information given (less than ½ of info is retained)
How to effectively TEACH clients
TEACH mnemonic:

Tune in-Listen before you start teaching.

Edit information-Teach necessary information first

Act on each teaching moment-Teach whenever possible. Develop a good relationship

Clarify often-Make sure your assumptions are correct. Seek feedback

Honor the (individual, family, group, community, population) as partner. Build on experience. Share responsibilty
Best way to promote learner retention
90 % of what they say as they do a thing
What are the 8 Factors that influence health behavior change
1) Intention

2) Environmental Constraints

3) Ability

4) Anticipated Outcomes

5) Norms

6) Self-Standards

7) Emotion

8) Self-Efficacy
The person has made a commitment to perform a behavior
Environmental Constraints
No external conditions or circumstances exist that make it impossible for the behavior to occur

** to facilitate health behavioral changes you need to create an environment that facilitates behavioral changes
The person has the skills necessary to perform a behavior
Anticipated outcomes
The person believes that the advantages (benefits) of performing the behavior outweigh the disadvantages (costs); the person has a positive attitude toward performing the behavior
The person perceives more social pressure to perform the behavior than not perform the behavior
The person perceives performance of the behavior as more consistent than inconsistent with his/her self image
The person’s emotional reaction to performing the behavior is more positive than negative
The person perceives that s/he has the capabilities for performing the behavior under a number of different circumstances
What is Cohesion?
Attraction of group members to one another
what is Conflict?
The opposite of harmony; antagonistic points of view
what is Group ?
A collection of interacting individuals who have a common purpose or purposes
what is group-culture ?
A composite of the group norms that comes to dictate perceptions and behaviors
what is leadership ?
Influencing others to achieve a goal
what is Member Interaction ?
The ways that group members behave and relate toward each other
what is Task functions ?
Behaviors that focus or direct movement toward the main work of the group
7 things that DECREASE group Cohesion & Productivity
1) Conflicts between personal and group goals

2) Lack of interest in group goals and activities

3) Poor problem solving and communication skills

4) Lack of leadership

5) Disagreement about leadership

6) Aversion to other members

7) Behaviors and attributes poorly understood by others
6 ways to Resolve Conflict
1) Give a full description of concerns and divergent views

2) Clarify assumptions on the conflict issue

3) Specify underlying factors, including beliefs, individual desires, and expectations

4) Identify the real issue or issues

5) Use a problem solving approach to search for a resolution

6) Find a resolution (which may be only a compromise)
6 types of Group Role Behavior are?
1) Follower

2) Gatekeeper

3) Leader

4) Maintenance Specialist

5) Peacemaker

6) Task Specialist
What is a Follower ?
Seeks and accepts the authority and direction of the group
what is a Gatekeeper ?
Controls outsiders’ access to the group
what is a Leader ?
Guides and directs group activity
What is a Maintenance Specialist?
Provides support for group members; holds the group together
What is a Peacemaker ?
Attempts to reconcile conflict
What is a Task Specialist ?
Focuses or directs movement
toward the main work of the group
What is meant by “the social determinants of health?
- making sure pt.'s environment is conducive to health & wellness

- Poorer people live shorter lives and are often more ill than the rich.

-This disparity has drawn attention to the remarkable sensitivity of health to the social environment.

-social environment here is educ, work, transportation, access to food/living wage that will enable person to achieve what we hope they can achieve
health is more than health care
social conditions – the jobs we do, the money we’re paid, the schools we attend, the neighborhoods we live in – are as important to health as our genes, our behaviors and even our medical care.

--working "upstream"
health is tied to the distribution of resources
The single strongest predictor of our health is our position on the class pyramid
racism imposes an added health burden
Past and present discrimination in housing, jobs, and education means that today people of color are more likely to be lower on the class ladder. But even at the same level, African Americans typically have worse health and die sooner than their white counter-parts.

-institutional racism ie: hospital wont allow nurse to wear a head covering
the choices we make are shaped by the choices we have
Individual behaviors – smoking, diet, drinking, and exercise – do matter for health.

But making good choices isn’t just about self-discipline. Some neighborhoods have easy access to fresh, affordable produce; others have only fast food, liquor joints and convenience stores
high demand + low control = chronic stress
It’s not CEOs dying of heart attacks, it’s their subordinates.

People at the top certainly face pressure but they are more likely to have the power and resources to manage those pressures.

The lower in the pecking order we are, the greater our exposure to forces that can upset our lives
chronic stress can be deadly
when threats are constant and unrelenting, our physiological systems don’t return to normal
Inequality-economic & political is bad for our health
The United States has by far the most inequality in the industrialized world – and the worst health
social policy is health policy
Social measures like living wage jobs, paid sick and family leave, guaranteed vacations, universal preschool and access to college, and guaranteed health care can further extend our lives by improving them.

-These are as much health issues as diet, smoking and exercise.
health inequalities are neither natural nor inevitable
Inequities in health – arising from racial and class-based inequities – are the result of decisions that we as a society have made. Thus, we can make them differently.
we all pay the price for poor health
It’s not only the poor but also the middle classes whose health is suffering.
Public Health & Public Policy
Public health is a governmental responsibility embodied in
- federal
- state
- local agencies
what are the 3 Policy Development Strategies
- these are the building blocks for how u go about building a policy that will positively effect your community

1) Bargaining--> u have to gather like-minded people & hash it out w/ your opponents--> "i'll support your policy if you'll support mine" --> negotiatioon

2) Information Through the Mass Media--> be media friendly "social marketing"

3) Health Information--> health info is not enough
Implementation & its role in creating policy
Authorization--has to be done by Congress & Appropriations committee

Rule making

Evaluation--> 2 types: formative & summative
- outcomes