PUBLIC HEALTH
Public Health
described as the art and science of preventing disease, prolonging life and promoting health through organized community efforts to benefit each citizen
SURVEILLANCE
describes and monitors health events through ongoing and systematic collection, analysis and interpretation of health data for the purpose of planning, implementing, and evaluating public-health interventions. Disease and other health event investigation -- systematically gathers and analyzes data regarding threats of health to the populations, ascertains the source of the threat, identifies cases and others at risk and determines control measures
DELEGATED FUNCTIONS
direct care tasks carried out by RNs under the authority of health-care practitioner as allowed by the law.
(2) CLASSICAL TIMES (3000 - 200 B.C.) --
drainage systems were built during this time; pharmaceutical preparations were developed; and efforts to embalm the dead were instituted. "Mosaic Law" prescribed rules for cleanliness and management of communicable diseases
COUNSELING
establishes and interpersonal relationship intended to increase or enhance capacity for self care and coping with the community, system, family, or individual.
Community Health Nursing Practice
has a focus on individuals and families where they live, work, and go to school. Care is setting specific, and the emphasis is on acute and chronic care.
COMMUNITY ORGANIZING --
helps community groups to identify common problems or goals, mobilize resources, and develop and implement strategies for reaching the goals they collectively have set.
SCREENING
identifies individuals with unrecognized health-risk factors or asymptomatic disease conditions in populations.
(2) NON-MODIFIABLE RISKS --
individual has little or no control (e.g., genetics; gender; age; environmental exposure)
The Health Belief Model
is narrow in scope and places a burden of action exclusively on the client -- it assumes that the only clients who will fail to act are those who have negative perceptions of a specific disease or the recommended health action. Interventions are generally focused on the alterations of a patient's perspective and are based on the
POLICY DEVELOPMENT & ENFORCEMENT -
laces health issues on decision-makers agendas, requires a plan of resolution, and determines needed resources, resulting in laws, rules, regulations, ordinances, and policies.
CASE FINDING
locates individuals and families with identified risk factors and connects them with resources.
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.
CASE MANAGEMENT
optimizes self-care capabilities of individuals and families and the capacity of systems and communities to coordinate and provide services.
ADVOCACY
pleads someone's cause or an act on someone's behalf, with the focus on developing the community, system, and individual or family's capacity to plead their own cause or act on their own behalf.
COALITION BUILDING
promotes and develops alliances among organizations or constituents for a common purpose.
2 UPSTREAM VIEWS -- where society is at the focus of change (i.e., MACROSCOPIC APPROACH): (1) MILIO's FRAMEWORK FOR PREVENTION -
relates the ability of an individual to improve health behavior to society's ability to provide options for healthy choices that are accessible and socially desirable.
HEALTH BELIEF MODEL (2nd Microscopic Model)
resulted from the desire to understand factors that influence preventive health behaviors. An assumption of the model is that major determinants of preventive health behavior is the avoidance of disease. The model was NOT designed to be generalized across disorders, so actions that relate to preventive health behaviors for each disease differ from one another.
CONSULTATION
seeks information and generates optional solutions to forsee problems or issues through interactive problem solving with the community, system, family, or individual.
MISSION OF PUBLIC HEALTH =
social justice, which entitles all people to basic necessities, such as adequate income and health protection and accepts collective burdens to make this possible.
(1) MODIFIABLE RISKS
those aspects of a person's health risk over which a person has control (e.g., smoking; drinking and driving; or living active v. sedentary life style are examples of modifiable risk factors)
Using a THEORETICAL PERSPECTIVE
to plan nursing care guides the student in assessing a nursing situation and allows a student to plan without losing focus.
SOCIAL MARKETING
uses commercial marketing principles and technologies for programs designed to influence the knowledge, attitudes, values, beliefs, behaviors, and practices of the population of interest.
"Health Promotion";
"Health Promotion" -- has always been an important aspect of nursing care. Nursing leaders such as Florence Nightingale recognize the importance of proper nutrition, rest, and hygiene to maintaining health. Health promotion and health protection are important aspects of community-health nursing. "HEALTH PROMOTION" (defined by Green and Kroiter) as -- "any combination of health education and related organizational, economic, and environmental supports for behavior of individuals, groups, or communities conducive to health" (defined by Parse (sp?)) as -- "that which is motivated by the desire to increase well-being and to reach the best possible health potential.
"COMMUNITY"
"a group or collection of locally based individuals interacting in social units and sharing common interests, characteristics, values, and/or goals
"HEALTH"
(1) Being sound in mind and spirit (2) freedom from physical disease or pain Definition of "health" eventually changed to reflect a focus on the curative aspect and then changed again to focus on the multi-dimensional aspects of health. WHO defines "HEALTH" as "a state of complete physical, mental, and social well-being . . . and NOT merely the absence of disease"
There are 5 stages in the disease history of humankind: (1) Hunting and Gathering (before 10,000 BC) <--
(1) Hunting and Gathering (before 10,000 BC) <-- (i) small groups wandered in search of food; (ii) nutrition was probably good; (iii) people likely suffered parasites like lice and pinworms; (iv) few contagious diseases because of lack of interaction (v) waste disposal was not a problem
Primary, Secondary, and Tertiary Levels of Prevention (cont...)
(1) Individual For the individual, PRIMARY PREVENTION might include dietary teaching during pregnancy or immunizations. SECONDARY PREVENTION for the individual might include HIV testing or screening for cervical cancer TERTIARY PREVENTION FOR THE INDIVIDUAL might include teaching a new client with diabetes how to administer insulin . . . or skin care for an incontinent patient
There are 2 types of focus for theories:
(1) MICROSCOPIC -- The Individual is the Focus of Change
The Proposed Healthy People 2020 Objectives have also been identified with 10 leading health indicators -- including:
(1) Physical activity; (2) Overweight/obesity (3) Tobacco Use (4) Substance abuse (5) Responsible sexual behavior (6) Mental Health (7) Injury and Violence (8) Environmental Quality (9) Immunization (10) Access to Health Care
HEALTHY PEOPLE 2020 The Healthy People 2020 proposed objectives have 2 broad goals:
(1) increase quality and years of healthy life (2) eliminate health disparities
(4) RENAISSANCE (15th; 16th; 17th Centuries)
(i) Characterized by Population Growth and Migration (ii) van Leeuwenhoek discovered microscopic organisms (iii) Elizabethan Poor Law in 1601 placed care for the poor under the guidance of local parishes
MIDDLE AGES (500 - 1500 A.D.)
(i) During Middle Ages, priests and monks became primary healthcare providers and applied magic and religion to solve problems (ii) Communicable diseases such as Diphtheria; Smallpox; Leprosy; and Bubonic Plague were rampant -- and in some cases: PANDEMIC (iii) Public health measures including building wells and fountains; cleaning streets and improving methods of refuge disposal
(5) 18th Century
(i) Imperialism and Industrialization produced many problems with sanitation (ii) Poor children were forced into labor (iii) Jenner began SMALLPOX vaccination
(6) 19th Century
(i) Unsanitary conditions remained (ii) communicable diseases flourished -- typhus and typhoid fever killed thousands (iii) health conditions and life expectancy of the poor in Great Britain resulted in the establishment of England's GENERAL BOARD OF HEALTH
Examples of Upstream Interventions include:
(i) identifying aggregates at risk for development of TB (ii) instituting measures to improve living conditions and nutrition for those at risk (iii) encouraging continuing research for new drugs to prevent and treat TB These efforts are designed to alter factors that contribute to poor health PRIOR to the disease.
(5) Present Period (1900's to Present)
(i) increased sedentary lifestyle and bad habits like smoking and substance abuse have had adverse effects on health (ii) dietary changes and individual behaviors have produced an increase in bowel diseases, venous disorders, and heart disease (iii) increase in some communicable diseases associated with overcrowding
(4) Industrial Cities (17 and 1800's)
(i) produced large amounts of industrial waste that resulted in heavy air and water pollution and harsh working conditions (ii) Epidemics like TB, diphtheria, smallpox, and measles
(2) Settled Villages (10,000 - 6000 BC)
(i) small groups of people settled together in permanent dwellings (ii) ZOONOSIS -- diseases capable of being passed from animal to human (iii) nutrient deficiencies common (iv) problems related to agrarian lifestyles = common (v) waste disposal and water availability were becoming problem
(3) Pre-industrial (to 1800A.D)
(i) waste disposal and availability of clean water supply became increasingly problematic (so diseases like Cholera and Plague became more common) (ii) incidence of other communicable diseases increased
The Public Health Intervention Wheel identifies 3 levels of Practice:
1) Community (2) Systems (3) The Individual or Family
PUBLIC HEALTH INTERVENTION WHEEL
A population based model that provides a framework for community and public health nursing practice. The levels of practice and interventions are directed toward improving population health.
NURSING WITH THE COMMUNITY (BELLACK, 1998)
As a community-health nurse working with a community, it's essential that the health agenda originates within the health community -- it is NOT imposed by others. A SHARED VISION OF HEALTH is a challenge because multiple viewpoints are the norm. SUCCESS depends on: (1) Listening (2) Being Patient (3) Providing accurate and scientifically sound information (4) Respecting the experiences of Community Members
What is "Community Public Health Nursing"?
COMMUNITY PUBLIC HEALTH NURSING -- the synthesis of nursing practice and public-health practice. It has the major goal to preserve the health of the community and surrounding population. Community public health nursing focuses on health promotion and health maintenance and is associated with health and identification of populations at risk, rather than an episodic response to patient demand.
CHALLENGES FOR COMMUNITY HEALTH NURSING
Community Health Nurses must work to promote the health of populations. When planning interventions, nurses should consider the new causes of morbidity and mortality. Nurses should be encouraged to focus on underserved populations and the provision of HOLISTIC CARE. Education and Community Health Nursing is greatly needed for the practicing nurse today.
CHANGING PERSPECTIVES ON MORTALITY IN 20th CENTURY AND BEYOND
Events in the past have influenced how population health is experienced and addressed today. There are new causes of mortality. Death rates from infectious diseases declined in 18th and 19th Centuries -- this decline was attributable to better nutrition, increased food production, water purification, sewage disposal, improved food handling, and pasteurization of milk. Medicine and Immunization programs had little impact until 1920's and 30's. Debate over relative importance of healthful living, versus curative approach still exists today. Focus of medical technology and academic sciences has stressed specific disease-focused causation. A shift needs to be made to identify major determinants of health and prevention of disease and disability. Additional theories of disease causation emerged. GERM THEORY = unicausal model and NOT sufficient to explain all disease . . . Multicausal views that consider the environment, stress, and lifestyle factors should be emphasized today. Several social and political changes have occurred in the U.S. that have affected the development of community health nursing -- e.g., INSURANCE. At turn of century, technology was scarce. Most healthcare (and even surgery) took place in the home -- result = healthcare costs were low. During 1920's and 30's, cost of healthcare increased as a result of urbanization, increased technology, and the acceptance of medicine as a science. As hospitals began to organize, they formed . . . THE AMERICAN HOSPITAL ASSOCIATION, whose leaders encouraged the development of Health Insurance Plans. Employers began to offer Health Insurance as part of Employee compensation during (and after) WW2. Federal and State movements during the 1960's supported development of health insurance for the poor and elderly populations . . . Still services covered by many insurance plans often do NOT include COMMUNITY-BASED HEALTHCARE.
LILLIAN WALD (1967 - 1940)
Lillian Wald was instrumental in the establishment of public health nursing in the U.S. HOUSE ON HENRY STREET -- Established by Lillian Wald and MARY BREWSTER = a district nursing service in New York in 1893. Philosophy = meet health needs of aggregates and help people help themselves Wald also instrumental in beginning SCHOOL NURSING in New York . . .
FLORENCE NIGHTINGALE (1820 - 1910)
Modern nursing began in mid 1800's largely through efforts of Florence Nightingale. Much of Nightingale's work centered on the influence of ENVIRONMENTAL FACTORS on health. Nightingale emphasized sanitation, community assessment, and analysis, use of statistics and gathering of census data, and political advocacy on behalf of aggregates Application of statistics to health and healthcare = important
Population-focused nursing
Nursing that focuses on the entire population.
Public Health Nursing Practice
Public Health Nursing Practice -- uses knowledge from nursing, social, and public-health sciences to promote and protect the health of populations. Practice is a systematic process of assessment, planning, implementation, and evaluation. Results of practice used (sp?) to promote health and prevent disease. The responsibility is to the population as a whole
3 Levels of Prevention
Public health efforts focus on health promotion and disease prevention, rather than on medical or illness care. HEALTH PROMOTION ACTIVITIES -- activities that improve well being. DISEASE PREVENTION ACTIVITIES -- protect people from disease and subsequent effects of disease. THERE ARE 3 LEVELS OF PREVENTION: (1) Primary Prevention -- prevention of problems before they occur, including health promotion and health protection (2) Secondary Prevention -- early detection and intervention or early diagnosis and treatment (3) Tertiary Prevention -- the correction and prevention of deterioration of a disease state . . . it helps with limitation of disability and rehabilitation
"RISK"
RISK" = the probability that a specific event will occur in a given time frame. A "RISK FACTOR" is an exposure that is associated with a disease or negative outcome. There are KNOWN risk factors (e.g., smoking with lung cancer), and there are ASSUMED risk factors (such as connection between cell phones and brain tumors) RISK ASSESSMENT = systematic way of distinguishing the risks posed by potentially harmful exposures
Relationship of Risk to Health
The Relationship of Risk to Health and Health promotion activities is directly related to the activities in which we participate, the food we eat, and the substances to which we are exposed. Where we live and work, as well as our gender, age, and genetic make-up also affect our health and the risk to our health.
THEORETICAL APPROACHES
The goal of theory = to improve nursing practice. This is achieved by using theories or parts of theoretical frameworks to guide practice. Theory-Based Practice guides data collection and interpretation in a clear and organized manner, making it easier for the nurse to diagnose and address health problems. Through the process of integrating theory and practice, the student can focus on factors that are critical to understanding the situation.
Determinates of Health and Disease
The health status of a community is associated with a number of factors -- e.g., health-care access; economic conditions such as poverty or affluence; social and environmental issues such as smoking, violence, led paint, or cultural practices. It is essential for the community-health nurse to understand the determinates of health and recognize the interaction of these factors that lead to disease, death, and disability. It has been estimated that individual behaviors are responsible for about 50% of premature deaths in the US
(1) Describe the impact of aggregate living on population health
The inter-relationship between an individual's health and individual's environment, and the nature and size of the individual's aggregate have all had effects on populations throughout history. Increasing population and population density have resulted in environmental changes that have caused ecological imbalance.
HEALTH CARE TODAY: Thinking "UPSTREAM" . . . (examining the root cause of poor health)
Thinking Upstream describes how healthcare workers are caught up with rescuing victims from the river through downstream endeavors or upstream endeavors. "Downstream Interventions" focus on correcting the problem AFTER it has occurred (e.g., victim has already fallen into the river) . . . Downstream interventions (i) pull the victim out (ii) are characterized by short-term, individual-based interventions (iii) Examples include: (a) Testing; Treating; and providing education for TB
UPSTREAM INTERVENTIONS
Upstream Interventions -- focus on preventing the problem before it happens. Find out who is pushing the victims into the water and then take measures to prevent it. Upstream interventions focus on modification of economic, political, and environmental factors to improve the health of the community.
WORLD HEALTH ORGANIZATION (WHO) defined "HEALTH"
a "State of complete well being, physical, social, and mental, and not merely the absence of disease or infirmity. In 1986, WHO defined "health" as "the extent to which an individual or group is able on the one hand to realize aspirations and satisfy needs and on the other hand, to change or cope with the environment." Health is thus seen as a resource for everyday life -- not the objective of living . . . it is a positive concept emphasizing social and personal resources and physical capacities.
For COMMUNITY-HEALTH NURSING,
a theory must be broad enough in scope to address health, and the determinates of health from a population perspective . . . (otherwise, the theory will not be very useful to community-health nurses)
REFERRAL AND FOLLOW UP --
assists individuals, families, groups, organizations, and/or communities to identify and access necessary resources to prevent or resolve problems or concerns.
(2) CRITICAL THEORETICAL PERSPECTIVE -
based on belief that life is structured based on social meanings, which are determined through social domination. Assumes that standards of truth are determined socially. Application of critical social theory necessitates inductive reasoning in which nurses assess concepts through an ongoing process of data collection and analysis. Political, economic interventions are seen as a most effective method of addressing the health of a population -- these interventions seek to eliminate illness at the source. Holds that each person is responsible for creating social conditions in which all members of the society are able to speak freely. Nurses are thereby challenged to expose power imbalances that prohibit people from achieving their full potential.
(i) OREM's SELF-CARE DEFICIT THEORY OF NURSING
based on premise that nursing is a response to one's incapacity to care for oneself because of one's health. Nursing thus assumes a role of providing all or some self-care activities on behalf of the patient. The concepts of self care, self-care deficit, and self-care agency are microscopic and difficult to apply to populations
COLLABORATION
commits two or more persons or organizations to achieve a common goal through enhancing the capacity or one or more of the members to promote and protect health.
HEALTH TEACHING --
communicates facts, ideas, and skills that change knowledge, attitudes, values, beliefs, behaviors, and practices of individuals, families, systems, and/or communities.
"HEALTH PROTECTION"
consists of those activities that one undertakes to prevent disease, detect the disease in early stages, or to maximize one's health within the constraints of the disease state. -
EVOLUTION OF EARLY PUBLIC HEALTH EFFORTS = 6 TIME PERIODS (1) PRE-RECORDED HISTORIC TIMES(Before 5000B.C)
crude efforts were taken to manage health (e.g., psychosomatic medicine -- voodoo; isolation through banishment; and smoke treatment)