public- class 3-ch 27,28 and class 2-ch2

African-American Nurses in PHN

1919: National Health Circle for Colored People Bessie M. Hawes 1936: PHN certificate program for African-American nurses Wage discrimination in the South Nursing education segregated until 1960s African-American nurses in the South were paid significantly lower salaries than their white counterparts for the same work.

Public Health Nursing from the 1970s into the 21st Century

1970s Hospice movement Birthing centers Day care for older adults and disabled persons Drug abuse programs Long-term rehabilitation care 1980s funding challenges High health care costs Shift from health promotion/disease prevention to acute care National Center for Nursing Research (NCNR) Official NIH status in 1993: National Institute of Nursing Research (NINR) The Institute of Medicine's report The Future of Public Health (1988) Healthy People initiative begins Programs for health promotion and disease prevention received less priority as funding was shifted to meet the escalating costs of acute hospital care, medical procedures, and institutional long-term care. NCNR/NINR: Through research, nurses analyze the scope and quality of care provided by examining the outcomes and cost-effectiveness of nursing interventions. With the concerted efforts of many nurses, NCNR gained official institute status within the National Institutes of Health in 1993, becoming the National Institute of Nursing Research (NINR). The Future of Public Health, Institute of Medicine (IOM, 1988): Found the United State's PH system in disarray and concluded that, although there was widespread agreement about what the mission of PH should be, there was little consensus on how to translate that mission into action. Reported that the mix and level of PH services varied extensively across the United States. Healthy People proposed a national strategy to improve significantly the health of Americans by preventing or delaying the onset of major chronic illnesses, injuries, and infectious diseases. 1990s health care concerns Cost Quality Access to direct care services Health care reform movement ANA, American Association of Colleges of Nursing (AACN), National League for Nursing (NLN), and 60 other nursing organizations join In 1991, the ANA, the American Association of Colleges of Nursing, the National League for Nursing, and more than 60 other specialty nursing organizations joined to support health care reform. The coalition of nursing organizations emphasized key health care issues of access, quality, and cost and proposed a range of interventions designed to build a healthy nation through improved primary care and PH efforts. 2000s Health care reform passed in 2010 with the federal Patient Protection and Affordable Care Act PHN organizations develop position papers on the following: Graduate education for advanced practice PHN Faculty qualifications for community/public health nursing educators Importance of PHN within PH systems

Positive Health Factors

1972 study shows 7 habits Decrease mortality and morbidity Sleep 7-8 hr Breakfast No snacking Appropriate weight No smoking Moderate EOTH exercise

Family Health

A dynamic relative state of well-being that includes the biological, psychological, spiritual, sociological, and cultural factors of the family system Holistic approach Dysfunctional families Balanced families-"healthy" families Family flexibility- able to adapt to new situations Family cohesion-family remains "intact" even if live appart Families are neither all good nor all bad; rather, all families have both strengths and difficulties. All families have seeds of resilience and strengths upon which the nurse should work with the family to build interventions and design plans of action. Nurses should view family behavior on a continuum of need for intervention. Families with strengths, functional families, and balanced families are terms often used to refer to healthy families that are doing well.

dysfunctional family

A popular term for nonhealthy families is dysfunctional families, also called noncompliant, resistant, or unmotivated—phrases that label families that are not functioning well with each other or in the world. Dysfunctional- not function well.

Contracting with Families

A working agreement that is continuously renegotiable and may or may not be written Contingency contract Non-contingency contract Process: Beginning phase Working phase Termination phase Advantages and Disadvantages

World War II: Extension and Retrenchment in PHN

Accelerated need for nurses Nursing Council on National Defense Rise in Army and Navy Nurse Corps Bolton Act of 1943: Cadet Nurses Corps Expansion of PHN scope of practice Emergency Maternity and Infant Care Act of 1943 Job opportunities The Nursing Council on National Defense was a coalition of the national nursing organizations that planned and coordinated activities for the war effort. Through the influence and leadership of U.S. Representative Frances Payne Bolton of Ohio, substantial funding was provided by the Bolton Act of 1943 to establish the Cadet Nurses Corps, leading to increased enrollment in schools of nursing at undergraduate and graduate levels. In some cases, PHN expanded its scope of practice, nurses increased their presence in rural areas, and many official agencies began to provide bedside nursing care. The federal Emergency Maternity and Infant Care Act of 1943 (EMIC) provided funding for medical, hospital, and nursing care for wives and babies of servicemen. Health services seeking EMIC funds were required to meet the high standards of the U.S. Children's Bureau, thus increasing quality of care for all. Job opportunities for PH nurses grew because they continued to constitute a large proportion of health department personnel. Between 1950 and 1955, the proportion of U.S. counties with full-time local PH services increased from 56% to 72%.

Collecting Pre-encounter Data

Actual or potential problem identified Possible referral sources Family, physician, school nurse, caseworker, hospital Pre-encounter data Referral source Family Previous records

Lilian Wald

An American public health nurse, settlement leader, and social reformer who founded the Henry Street Settlement in New York to bring nursing care into the homes of the poor. She was also instrumental in establishing the school nursing system, the federal government's Children's Bureau, and the Nursing Service Division of the Metropolitan Life Insurance Company.

National leage of nursing

An organization concerned with the improvement of nursing education and nursing service and the provision of health care in the United States. Among its many activities are preadmission and achievement tests for nursing students and compilation of statistical data on nursing personnel and trends in health care delivery.

Which was a leading cause of the rise in chronic illness deaths? A. National crude mortality rate B. Growth of an aging population C. Rise in communicable diseases D. Decrease in home nursing services

Answer is B. Growth of an aging population meant that people started living long enough to develop more chronic illnesses.

Empowering Families

Approaches for helping individuals and families assume an active role in promoting their health care Access and control over needed resources Decision-making and problem-solving abilities The ability to communicate and to obtain needed resources

Making an Appointment

Assessment is reciprocal. Family also assessing PHN at same time. Introductions: explain the purpose Do not apologize. Arrange a time that is— Convenient for all parties Allows the greatest number of family members to be present If appropriate, offer an interpreter. Confirm appointment. Place, time, date, and directions Data collection starts immediately upon referral to the nurse. These are suggestions that will make the process of arranging a meeting with the family easier.

Health Risk Reduction

Based on the assumption that decreasing the number of risks or the magnitude of risk will result in a lower probability of an undesired event occurring. Better if voluntarily assessed risk reduction than imposed. Motivation. Pender (2010) provides examples of different kinds of risks: Voluntarily assumed risks are better tolerated than those imposed by others. Risks over which scientists debate and as a result have some level of uncertainty as to their magnitude are more feared than risks on which scientists agree. Risks of natural origin are often considered less threatening than those created by humans. Risk reduction is a complex process that requires knowledge of the specific risk and the family's perceptions of the nature of the risk.

Determining Where to Meet

Before contacting the family to arrange for the initial appointment, the nurse decides the best place to meet with the family. Home Clinic Office

Community Organization and Professional Change

Civil Rights Movement Funding increases in certain areas Economic Opportunity Act New programs addressed economic and racial differences in health care services and delivery. Funding was increased for maternal and child health, mental health, mental retardation, and community health training. Beginning in 1964, the federal Economic Opportunity Act provided funds for neighborhood health centers, Head Start, and other community action programs. Neighborhood health centers increased community access for health care, especially for maternal and child care.

PHN Works with Families for Healthy Outcomes

Collecting pre-encounter data Determining where to meet the family Making an appointment with the family Planning for your own safety Interviewing the family: defining the problem Family assessment instruments Family health literacy Designing family interventions Evaluating the plan

Challenges for Nurses Working with Families in the Community

Definition of family Transitions of care Uninsured, underinsured, and limited services Social and family policy challenges Historically, family demographics can be analyzed by looking at data about the families and household structures and the events that alter these structures. Nurses draw on family demographic data to forecast and predict family community needs, such as family developmental changes, stresses, and ethnic issues affecting family health, as they formulate possible solutions to identified family community problems. In 2007, in the United States, there were more than 11.2 million households, with 67% being family households and the remaining 33% being nonfamily households. Family households include a householder and at least one other member related by birth, marriage, or adoption; a nonfamily household is either a person living alone or a householder who shares the house only with nonrelatives, such as boarders or roommates.

Definition of Family

Definition used by family system and family nurses Family refers to two or more individuals who depend on one another for emotional, physical, or financial support; the members of the family are self-defined. Definitions are broadening as nontraditional families increase. Do not have to be related by blood. Now more than ever, the traditional definition of family is being challenged with the legalization of same-sex marriages. Public health nurses and family nurses struggle on a daily basis with the conflict between the narrow traditional legal definition of family used in the health care system and by social policy makers and the broader term used by the family. Public health nurses and family nurses struggle on a daily basis with the conflict between the narrow traditional legal definition of family used in the health care system and by social policy makers and the broader term used by the family.

District Nursing and Settlement Houses

Deplorable immigrant tenement housing and sweatshops District nursing and settlement houses (Lillian Wald) Rural Nursing Service Occupational health Visiting nurses became key to the prevention of communicable disease education campaign. Settlement houses were established. These were neighborhood centers that became hubs for health care, education, and social welfare programs. Henry Street Settlement; Visiting Nurse Service of New York City (Lillian Wald) By 1905, PH nurses had provided almost 48,000 visits to more than 5000 clients (Kalisch & Kalisch, 1995) Lillian Wald (see Figure 2-2) emerged as the established leader of PH nursing during its early decades The American Red Cross, through its Rural Nursing Service (later the Town and Country Nursing Service), provided a framework to initiate home nursing care in areas outside larger cities. Occupational health nursing Began as industrial nursing and was a true outgrowth of early home visiting efforts. In 1895, Ada Mayo Stewart began working with employees and families of the Vermont Marble Company in Proctor, Vermont (free service for the employees). As a free service for the employees, Stewart provided obstetric care, sickness care (e.g., for typhoid cases), and some postsurgical care in workers' homes. Unlike contemporary occupational health nurses, Stewart provided very few services for work-related injuries.

Evaluation of the Plan

Determine whether The plan is working. The plan is working fast enough to address the problem. The plan is addressing only part of the problem. The plan needs to be revised based on changes. If plan is not working, identify barriers Family apathy Family indecision Nurse-imposed ideas Negative labeling and the like

Family Nursing Process

Develop Problem list via : interview assessment tools and family theories referral information Plan: What needs to be done for family How will needs /problem be addressed Evaluate results of plan

Between the Two World Wars

Economic depression Agencies and communities not prepared to address the increased needs and numbers of impoverished Decreased funding Agencies to support nurse employment Federal Emergency Relief Administration (FERA) Works Progress Administration (WPA) Relief Nursing Service Civil Works Administration (CWA) programs 1932 survey found only 7% of nurses working in PH were adequately prepared. Economic Depression Agencies and communities were unprepared to address the increased needs and numbers of impoverished. Decreased funding meant decreased number of employed nurses in hospitals and in the community.

Health concerns are international.

Emerging/re-emerging communicable diseases such as H1N1 influenza and the Ebola virus underscore the global nature of health concerns.

England's Elizabethan Poor Law

England's Elizabethan Poor Law guaranteed medical care for poor, blind, and "lame" individuals, even those without family. Colonial America's ideas of social welfare and care of the sick were strongly influenced by this law. Pennsylvania Hospital was the first hospital in what would become the United States.

Family systems theory

Families are social systems. Maintain stability by adapting to internal and external stressors. Change in one part of system effects remainder Goal to maintain homeostasis within system

Four Approaches to Family Nursing

Family as context Family as client Family as a system Family as a component of society

Family as system

Family as interactional client Whole is more than the sum of its parts Interactions among family members become the focus. All are affected by events.

Family Caregivers

Family caregivers: 30% of American adults Most provide care for someone 50 or older Most are themselves over 50 (12% older than 65) Growing trend: children as caregivers Estimated at 1.3-1.4 million kids-kids having to take care of others Affects children's health and school performance Nurses can work with families who are providing care to their family member in the following ways (National Alliance for Family Caregiving, 2009): Identify and help caregivers who are most at risk for deteriorating health, financial security, and quality of life so that they can continue to provide care while maintaining their own well-being. Identify and advocate for programs that make a real difference in caregivers' well-being and in their ability to continue providing care. Identify and promote the use of technologies that can facilitate caregiving. Extend the reach of caregiver programs to all caregivers regardless of the age of their care recipient. Encourage families to plan proactively for aging and potential health/disability issues.

Social and Family Policy Challenges

Family policy Social policy Health care access and coverage, low-income housing, social security, welfare, food stamps, pension plans, affirmative action, and education Family medical leave (1993) Debate as to what constitutes a family Teen pregnancy prevention Health care insurance Affordable Care Act (2010)

Family as client

Family primary Individual secondary Family = the sum of its members Response of the family as a whole -ENTIRE Family is the client

Health of Families

Family promotes both: healthy and unhealthy behaviors These factors are dynamic with each effecting the other Pratt: described the energized family Negative Effect of illness on families Role of family in the cause of disease-diet, activity, hygiene, immunization , overcrowding Abuse , neglect, Role of family in its use of services: public health, welfare,  NEED: effective family policies on : Health promotion and risk reduction

Births

Fertility rates differ by race and ethnicity. Not all cultures value limiting the number of children in a family. Increase in mother's age at first birth Average is 25.4 years of age Substantial increase in number of children born outside of marriage-44% all births US Teen birthrate lowest ever. Huge decrease since 1991.

Nightingale and Rathbone

Florence Nightingale designed and implemented the first program of trained nursing, and her contemporary, William Rathbone, founded the first district nursing association in England.

Florence Sarah Lees Craven

Florence Sarah Lees Craven shaped the profession through her Guide to District Nurses, which recommended, for example, that nursing care during the illness of one family member provided the nurse with influence to improve the health status of the whole family

Family development and life cycle theory

Focuses on predicted stresses of families as they change and transition over time. Adjust to normative stresses. Predict normal stresses that family expereince. family move as a system to different level of functioning. start as married couple... baby born...

district nursing association

Founded in Liverpool, England, by philanthropist William Rathbone to provide nursing care for poor and suffering people similar to the care that his terminally ill wife had received.

Home Visits

Give a more accurate assessment of the family structure, the natural or home environment, and behavior in that environment Provide opportunities to identify both barriers and supports for reaching family health promotion goals Advantages Disadvantages

Uninsured, Underinsured, and Limited Services

Goals of Affordable Care Act (ACA) Provide patient protection. Ensure availability of affordable health care. Decrease the overall cost of health care. The remaining uninsured Undocumented immigrants Citizens who choose not to enroll in Medicaid Residents of states that opt out of Medicaid Expansion provision (voluntary program) Uninsured clients are those who do not have health insurance for any family member. Underserved are individuals who have minimal insurance coverage and usually have a high deductible. Individuals with limited services are people who may have troubling accessing health care or experience barriers to health care. Insurance or not having insurance puts families at risk.

Major Family Health Risks and Nursing Interventions

Healthy People 2020 target areas Health protection activities Family health risk appraisal Biological and age-related risk Biological health risk assessment Environmental risk Environmental risk assessment Behavioral (lifestyle) risk Behavioral (lifestyle) health risk assessment Healthy People 2020 targets areas in health promotion, health protection, preventive services, and surveillance and data systems to describe age-related objectives (USDHHS, 2010). Included in the area of health promotion are physical activity and fitness, nutrition, tobacco use, use of alcohol and other drugs, family planning, mental health, mental disorders, and violent and abusive behavior. Health protection activities include issues related to unintentional injuries, occupational safety and health, environmental health, food and drug safety, and oral health. Preventive services, designed to reduce risks of illness, include maternal and infant health, heart disease and stroke, cancer, diabetes, and other chronic disabling conditions, human immunodeficiency virus (HIV) infection, sexually transmitted diseases, immunization for infectious diseases, and clinical preventive services. The interrelationships among the various groups of risk are clear when the objectives for the nation are considered. Most of the national health objectives are based on risk factors of groups or populations in a variety of categories like age, gender, health problem. However it is important to recognize that some of these factors also relate to and have potential effects on the individuals' families, work, school, and communities.

Marriage, Divorce, and Cohabitation

Higher age for first marriage Divorce rate for people 50 years or older doubled between 1990 and 2010. Remainder<. Increased occurrence of cohabitation Potential for negative child well-being Parental separation 5 times more likely than for married couples Increase in unstable living situations (higher number of transitions)-> behavioral and cognitive problems Higher poverty in cohabitating families rate of Cohabitation refers to a couple living together who are having a sexual relationship without being married.

Declining Financial Support for Practice and Professional Organizations

Hospitals preferred for illness and childbirth Funding stopped for visiting nurse services Consolidation of national nursing organizations National League for Nursing (NLN) American Nurses Association (ANA) Consolidation of national nursing organizations NOPHN, the National League for Nursing Education, and the Association of Collegiate Schools of Nursing were dissolved in 1952. Their functions were distributed primarily to the new National League for Nursing (NLN) and the American Nurses Association (ANA), which merged with the National Association of Colored Graduate Nurses and continued as the second national nursing organization.

PH During America's Colonial Period and the New Republic

Household members (usually women) tended to the sick. Urbanization in the early 1800s caused this system to became insufficient. England's Elizabethan Poor Law of 1601 1751 Pennsylvania Hospital founded Early colonial PH efforts After American Revolution First PH committee was established In the early years of America's settlement, as in Europe, the care of the sick was usually informal and was provided by household members, almost always women. The female head of the household was responsible for caring for all household members, which meant more than nursing them in sickness and during childbirth. She was also responsible for growing or gathering healing herbs for use throughout the year. Early colonial public health efforts included the collection of vital statistics, improvements to sanitation systems, and control of any communicable diseases introduced through seaports. Colonists lacked a mechanism to ensure PH efforts would be supported and enforced. Epidemics taxed the limited organization for health during the 17th, 18th, and 19th centuries.

Designing Family Interventions

ID primary and secondary problems We need the following type of help We need the following information We need the following supplies We need to contact the following people To make our family action plan happen, we need to ... (List five things in the order they need to have happen.)

Transitions of Care

Improved communication = better outcomes What helps achieve this? Nurses' hours match family schedules Family member bringing companion to office visits Enhances shared decision making Improves sharing of information Involving family in client's care Improves self-management of care Results in fewer medication errors Improves health outcomes

Immigration

In 2010, 20% of all U.S. births were to mothers born outside the country Illegal immigrants Do not quality for public benefits Do not qualify for health care Nurses need the following: Strong cultural literacy Strong knowledge of cultural health beliefs

Parenting

Increasing number of nontraditional roles Blended households-16% kids Single (never married) mothers-less likely to get child support Divorced mothers- income is 50% less than marrieds Single fathers Grandparents raising grandchildren Single mothers, never married, are particularly disadvantaged; they are younger, less well educated, and less often employed than are divorced single mothers and married mothers (Casper et al, 2015). Mothers who never married (25%) are much less likely to get child support from the father than are mothers who are divorced or separated (43%) (Casper, Florian and Brandon, 2015). Divorced mothers are substantially better educated and more often employed than are mothers who are separated or who never married. However, the average incomes of families headed by divorced mothers is less than half that of two-parent families (Casper et al, 2015). 64% kids live with 2 married parents 5% with 2 unmarried parents 30% live in single parent or other types families In general families are spending more time with their kids than in the past.

Family as context

Individual first -contact patient Family second Family as influence on pt Family as helpers

Home Visit Process

Initial phase Pre-visit phase In-home phase Termination phase Post-visit phase Five skills: Observing, listening, questioning, probing, and prompting

Health Risk

Know the families strengths and needs Increased risk with transitions from one stage to another . New situations and demands Non-normative changes unplanned/ unexpected Normative -usual and expected

PHN in Official Health Agencies and in Word War I

Late 1800s: local health departments formed Federal role in PH gradually expanded 1912: U.S. Public Health Service role defined National Organization for Public Health Nursing (NOPHN) loaned a nurse to the U.S. Public Health Service First federal government sponsorship of nurses World War I depleted the ranks of PHNs 1918: worldwide influenza pandemic In the late 1800s, local health departments were formed in urban areas to target environmental hazards associated with crowded living conditions and dirty streets and to regulate public baths, slaughterhouses, and pigsties. In 1912, the federal government redefined the role of the U.S. Public Health Service, empowering it to "investigate the causes and spread of diseases and the pollution and sanitation of navigable streams and lakes" (Scutchfield & Keck, 1997, p 15). WWI: Red Cross agreed that the greatest patriotic duty of PHNs was to stay at home. The 1918 flu pandemic swept the United States within 3 weeks. Houses, churches, and social halls were turned into hospitals to care for immense numbers of sick and dying.

Planning for Your Own Safety

Leave a schedule at your office. Plan the visit during safe times of day. Dress appropriately. Avoid secluded places. Obtain an escort if needed. Sit between the client and the exit. If you feel unsafe, do not visit or leave immediately. Check in with work at the end of the day. It is critical to plan for your own safety when you make a home visit. Learn about the neighborhood you will be visiting, anticipate needs you may have, and determine if it is safe for you to make the home visit alone or if you need to arrange to have a security person with you during the visit. Always have your cell phone fully charged and readily available. In addition, these strategies will help to ensure your own safety when you visit families in their homes.

Metropolitan Life insurance

Life insurance company that paid for or directly provided home nursing services for its beneficiaries and their families from 1909 to 1952.

Family Demographics

Living arrangements Marriage, divorce, and cohabitation Births Parenting Immigration Family caregivers-mom? Dad? Historically, family demographics can be analyzed by looking at data about the families and household structures and the events that alter these structures. Nurses draw on family demographic data to forecast and predict family community needs, such as family developmental changes, stresses, and ethnic issues affecting family health, as they formulate possible solutions to identified family community problems. In 2007, in the United States, there were more than 11.2 million households, with 67% being family households and the remaining 33% being nonfamily households. Family households include a householder and at least one other member related by birth, marriage, or adoption; whereas a nonfamily household is either a person living alone or a householder who shares the house only with nonrelatives, such as boarders or roommates.

New Resources and New Communities: The 1960s and Nursing

Medicare and Medicaid Did not include coverage for preventive services Home health care reimbursed only if ordered by a physician Increase in for-profit home health agencies Reduction in health promotion and disease prevention by local and state health departments In 1965, Congress amended the Social Security Act to include health insurance benefits for older adults (Medicare) and increased care for the poor (Medicaid). Unfortunately, the revised Social Security Act did not include coverage for preventive services, and home health care was reimbursed only when ordered by the physician. Many local and state health departments rapidly changed their policies to allow the agencies to provide reimbursable home care as bedside nursing. This often resulted in reduced health promotion and disease prevention activities. From 1960 to 1968, the number of official agencies providing home care services grew from 250 to 1328, and the number of for-profit agencies continued to grow (Kalisch & Kalisch, 1995).

Family Structure

Member characteristics and demographics Age, sex, number, and so on Factors in determining family structure The individuals who compose the family The relationships between them The interactions between the family members The interactions with other social systems Family structures have changed over time to meet the needs of the family and society. The great speed at which changes in family structure, values, and relationships are occurring makes working with families at the beginning of 21st century exciting and challenging. Social systems- law, health care, public services.

Paying the Bill for PHNs

Metropolitan Life Insurance Company Sheppard-Towner Act Individual commitment and private financial support Frontier Nursing Service (FNS) Paying the bill for nursing services in the community 1909 - The Metropolitan Life Insurance Company began a cooperative program with visiting nursing organizations. The nurses assessed illness, taught health practices, and collected data from policyholders. Sheppard-Towner Act (1921) - Provided federal matching funds to establish maternal and child health divisions in state health departments. Ended in 1929. Some community-oriented nursing innovations were the result of individual commitment and private financial support, such as the Frontier Nursing Service (1925) (Mary Breckinridge). Frontier Nursing Service influenced the development of public health programs geared toward improving the health care of the rural and often inaccessible populations in the Appalachian region of southeastern Kentucky (Browne, 1966; Tirpak, 1975). Breckinridge introduced the first nurse-midwives to the United States when she deployed Frontier Nursing Service nurses trained in nursing, public health, and midwifery.

micro, meso, exo, macro, chrono systems=bioecologic theory

Microsystems = systems and individuals that the family directly interacts with daily Mesosystems = systems the family interacts with frequently but not on a daily basis Exosystems = external environments that have an indirect influence on the family (e.g., economic system, local and state political systems, religious system, the school board, community/health and welfare services, the social security office, or protective services) Macrosystems = broad ideological and cultural values, attitudes, and beliefs Chronosystems = time-related contexts in which changes that have occurred over time may influence any or all of the other levels/systems (e.g., death of a young parent, a divorce and remarriage, war, or natural disasters)

5 systems

Microsystems: systems and individuals that the family directly interacts with daily Mesosystems: systems the family interacts with frequently but not on a daily basis Exosystems: external environments that have an indirect influence on the family= childs parent's workplace Macrosystems: broad ideological and cultural values, attitudes, and beliefs Chronosystems: time-related contexts in which changes that have occurred over time may influence any or all of the other levels/systems

Professional Nursing Education for PHN

NLN adopted Esther Lucile Brown's Nursing for the Future (1948) Recommended to establish basic nursing preparation colleges and universities Included PHN concepts in all baccalaureate programs; however, these were very brief components of the curricula 1950s: PHN education drew closer to university schools of nursing Broad principles of general nursing education were adopted and applied.

National Health Circle for Colored People

National Health Circle for Colored People (1919) was established to promote public health work in African-American communities in the South; it provided scholarships to assist African-American nurses pursue university-level public health nursing education. Bessie M. Hawes, the first recipient of the scholarship, completed the program at Columbia University (New York) and was then sent by the Circle to Palatka, Florida. In this small, isolated lumber town, Hawes' first project was to recruit school-age girls to promote health by dressing as nurses and marching in a parade while singing community songs. She conducted mass meetings, led mother's clubs, provided school health education, and visited the homes of the sick. Eventually she gained the community's trust, overcame opposition, and built a health center for nursing care and treatment.

The Profession Comes of Age

National Organization for PHN (NOPHN) Standardize PHN education 1914: first posttraining school course in PHN, 1920s to 1930s; many newly hired PHNs had to verify completion in a certificate program in PHN American Public Health Association (APHA) 1872: sought interprofessional teamwork Promoted "practical application of public hygiene" National Organization for PHN (NOPHN) Sought "to improve the educational and services standards of the public health nurse, and promote public understanding of and respect for her work" (Rosen, 1958, p 381). Lillian Wald elected as its first president. Membership included both nurses and their lay supporters.

The Rise of Chronic Illness

National crude mortality rate drops 47% Change in leading cause of death From communicable to chronic diseases Aged population rises with chronic disease More home care programs Reimbursable by commercial health insurance and later by Medicare and Medicaid Resurgence in combination agencies Between 1900 and 1955, the national crude mortality rate decreased by 47%. Many more Americans survived childhood and early adulthood to live into middle and older ages. Leading causes of death changed from communicable diseases (e.g., pneumonia) to chronic diseases (e.g., heart disease). Nurses contributed to these reductions in communicable diseases through immunization campaigns, improved nutrition, and better hygiene and sanitation. Additional factors included improved medications, better housing, and innovative emergency and critical care services. As the aged population grew from 4.1% of the total in 1900 to 9.2% in 1950, so did the prevalence of chronic illness. Some visiting nurse associations adopted coordinated home care programs to provide complex, long-term care to the chronically ill, often after long-term hospitalization. The increased prevalence of chronic illness also encouraged a resurgence in combination agencies—the joint operation of official (city or county) health departments and voluntary visiting nurse agencies using a unified staff. Nurses wanted services to be provided in a coordinated, cost-effective manner respectful to the families served and to avoid duplication of care.

America Needs Trained Nurses

Need for PH nursing Increase of women in workforce Economic advantage of home-visiting nurses Origins of organized nursing 1870s: first Nightingale model nursing schools 1877: Women's Board of the New York City Mission hired Frances Root 1878: Ethical Culture Society of New York hired four nurses to work in dispensaries 1885-1886: visiting nurse associations Need for PH nursing Trained nurse graduates usually worked in private duty nursing or held the few positions of hospital administrators or instructors. Private-duty nurses might live with families of patients receiving care, to be available 24 hours a day. The cost of private-duty nursing care for the sick at home was prohibitive for all but the wealthy. The care of the sick poor at home was made economical by having home-visiting nurses attend several families in a day rather than attend only one patient as the private-duty nurse did. Origins of organized nursing During the 1870s, the first nursing schools based on the Nightingale model opened in the United States. 1877 - Women's Board of the New York City Mission hired Frances Root to visit sick poor persons. 1878 - Ethical Culture Society of New York hired four nurses to work in dispensaries. 1885-1886 - Visiting nurse associations were established in Buffalo, New York, Philadelphia, and Boston.

Nightingale and the Origins of Trained Nursing

Need for nurses Origins of organized nursing Pastor Theodor Fliedner Crimean War Improvements using a population-based approach Principles of nursing "Health of the unity is the health of the community" "Sick nursing" versus "health nursing" Proper nutrition, rest, sanitation, and hygiene Need for nurses: Previous caregiving structures, which relied on assistance of family, neighbors, and friends, became inadequate in the early 19th century because of human migration, urbanization, changing demand, and an increasingly complex practice of medicine. 1984; Palmer, 1983). Rathbone's wife had received outstanding nursing care from a Nightingale-trained nurse during her terminal illness at home. He wanted to offer similar care to relieve the suffering of poor persons unable to afford private nurses.

Family Health-Neuman systems model

Neuman Systems Model Family health is defined in terms of a system. Wellness oriented . Wellness in the face of change .System stability as characterized by five interacting sets of factors/variables: Physiological Psychological Sociocultural Developmental Spiritual Families have flexible external line of defense, internal line of resistance. Focus on strengths.

Public Health Nursing Today

New challenges Needs of new populations (immigrants) Nurses leaving PHN for higher salaries Association of Community Health Nurse Educators calls for increased graduate programs to educate public health nurse leaders, educators, and researchers. Natural disasters require innovative responses. Floods, hurricanes, tornadoes Manmade disasters and bioterrorism Increased demand for well-prepared nurses

Living Arrangements

Number of households tripled since 1940. 2010-117 million households Largest growth: people living alone Higher life expectancy = more single-person households. 27% households.66% widows,44%>65 Impact on health care Single individuals may delay seeking care. Transportation (especially with older singles) may be a problem. Isolation (living farther away from other family members who could help) Cohabitation is a couple living together who are having a sexual relationship without being married.

Role of Communication

Nurses play pivotal role in communication among health care agencies and between agencies and the client's home. Problems with communication Incomplete or missing documentation from rushed assessments Low health literacy levels Failure to use current evidence-based practices Consequences of poor communication Higher risk of readmission Poorer outcomes

Family Crisis

Occurs when the family is not able to cope with an event or multiple events and becomes disorganized or dysfunctional Demands of the situation exceed the resources of the family.

Family as component of society

One of many institutions Primary unit of society Sees families as populations

Nightingale

Origins of organized nursing Nightingale studied nursing "system and method" by visiting Pastor Theodor Fliedner at his deaconess training school in Kaiserswerth, Germany. Nightingale implemented her ideas about nursing during the Crimean War. Nightingale progressively improved soldiers' health outcomes using a population-based approach that strengthened environmental conditions and nursing care. Using simple epidemiologic measures, she documented a decreased mortality rate from 415 per 1000 at the beginning of the war to 11.5 per 1000 at the end (Cohen, 1984; Palmer, 1983).

Health

Pender Health Promotion Model: Motivation to: Protect own health Promote own health Develop health abilities and resources to meet developmental tasks. Nurse helps promote these

Health Risk Appraisal

Process of assessing for the presence of specific factors in each of the categories that have been identified as being associated with an increased likelihood of an illness, such as cancer, or an unhealthy event, such as an automobile accident Youth Behavioral Health Risk Appraisal instrument (CDC)

Health Risk

Risk Factors that influence unhealthy result: Types health Risk: Inherited biological risk: Age-related risks eg CVD, diabetes, osteoporsis Social - substance abuse, homelessness physical environment risks-poor housing, lead Behavioral risk Combined risk ups likely hood of disease

School Nursing in America

School absences due to infections and communicable diseases Lina Rogers: first U.S. school nurse Illness was often not the reason for absence. Significant and positive impact More nurses hired School nursing spread to major cities. The children suffered from the common conditions of pediculosis, ringworm, scabies, inflamed eyes, discharging ears, and infected wounds. The school nurses found that "many children were absent for lack of shoes or clothing, because of malnourishment, or because they were serving their families as babysitters" (Hawkins, Hayes, & Corliss, 1994, p 417).

Shattuck Report

Shattuck Report was published in 1850 by the Massachusetts Sanitary Commission with an emphasis on the public's health. The report called for major innovations: the establishment of a state health department and local health boards in every town; sanitary surveys and collection of vital statistics; environmental sanitation; food, drug, and communicable disease control; well-child care; health education; tobacco and alcohol control; town planning; and the teaching of preventive medicine in medical schools. However, these recommendations were not implemented in Massachusetts for 19 years, and in other states much later.

Health of the Nation

Shift from infectious disease to chronic disease as leading cause of death Link between lifestyle and health Growing body of literature supports that lifestyle and the environment interact with heredity to cause disease Surgeon General's Report on Health Promotion and Disease Prevention (1979) Healthy People 2020

Increasing Federal Action for the Public's Health

Social Security Act of 1935 Funded opportunities for education and employment of PHNs Funded assistance to states, counties, and medical districts in establishing adequate health services Provided funds for research and investigation of disease The Social Security Act of 1935 provided funding for expanded opportunities for health protection and promotion through education and employment of PH nurses.

Interviewing the Family

Start informally. Casual banter. Involve each family member. Then Shift to formal interview Ask family to share their story. Ask how can I best help you and your family? What are your needs for assistance now? What is the greatest challenge facing your family now? What has been the most/least helpful for you? Who has been most impacted by The following specific therapeutic questions have been found to provide important family information: What is the greatest challenge facing your family now? On which family member do you think the illness has the most impact? Who is suffering the most? What has been most and least helpful to you in similar situations? If there is one question you could have answered now, what would that be? How can I best help you and your family? What are your needs/wishes for assistance now? Box 27-3 lists a variety of additional interview questions that will help uncover the family story.

Community Resources

Telehomecare Family policy Family and Medical Leave Act (FMLA) (1993) Vulnerable population: LGBT families at risk

ecomap

The ecomap is a visual diagram of the family unit in relation to other units or subsystems in the community. The ecomap serves as a tool to organize and present factual information and thus allows the nurse to have a more holistic and integrated perception of the family situation. The ecomap shows the nature of the relationships among family members and between family members and the community; it is an overview of the family, picturing both the important nurturing and the important stress-producing connections between the family and its environment.

genogram

The genogram displays pertinent family information in a family tree format that shows family members and their relationships over at least three generations. The genogram shows family history and patterns of health-related information, which is a rich source of information for planning interventions. The identified client and his or her family are highlighted on the genogram. Genograms enhance nurses' abilities to make clinical judgments and connect them to family structure and history.

change and continuity

Threats to health change, but foundational principles and goals of PHN remain the same Many communicable diseases are controlled in the United States: diphtheria, cholera, typhoid fever Others continue to affect many lives across the globe: HIV, poliomyelitis, tuberculosis

Pender's Health Promotion model

To promote health and protect health. Pender's Health Promotion Model, described in the latest 2010 edition of her textbook, continues to be useful in research that is done with families. This health promotion model states there are two factors that motivate individuals to participate in positive health behaviors. One is a desire to promote one's own health, using behaviors that have been determined to increase the individual, family, community and society's well-being, and in the process, actually moving toward not only individual self actualization, but a society actualization as well. The second factor is a desire to protect health, using those same behaviors in an effort to decrease the probability of ill health and provide active protection against illness and dysfunction in families. Understanding family health risk requires an examination of several related concepts: family health, family health risk, risk appraisal, risk reduction, life events, lifestyle, and family crisis.

After the American Revolution

U.S. Public Health Service (PHS) Established in 1798 as the Marine Hospital Service Early experiments in providing nursing care at home Ladies Benevolent Society of Charleston (1813) Philadelphia lay nurses Roman Catholic Sisters of Charity (1854) Shattuck Report (1850) by the Massachusetts Sanitary Commission After the American Revolution, the threat of disease, especially yellow fever, brought public support for establishing government-sponsored, or official, boards of health. Public Health Service was established in 1798 as the Marine Hospital Service; it provided health care for merchant seamen and protected seacoast cities from epidemics; PHS is still the most important federal public health agency today.

increased need for nurses

Urbanization, industrialization, and immigration in the United States increased the need for trained nurses

Functional health literacy techniques

Use black ink on white paper. Use short sentences. Use bullets no longer than seven items. Write information at the fifth-grade reading level. Remove all extra words. Print in upper- and lowercase letters. If using a computer, use 14-point font with a high-contrasting Arial (or other sans serif) typeface. Have plenty of white space. Rather than spend time determining the extent of the health literacy in a family, it is most important that nurses employ these techniques when writing out plans of care, listing directions, discussing medication management, or writing telephone numbers. Families retain more information when nurses use a variety of communication methods, including both visual materials and visual language. Families need direct clear information to assist in their decision making and carrying out the plans of action.

Family Functions and Structures

Ways in which families meet the needs of— Each family member The family as a whole Their relationship to society Family functions Economic function Reproductive function Socialization function Affective function-how bonded you are together Health care function

William Rathbone

William Rathbone First district nursing association in Liverpool, England Rathbone and Nightingale Nursing in the home District nursing throughout England Florence Sarah Lees Craven Guide to District Nurses Rathbone's wife had received outstanding nursing care from a Nightingale-trained nurse during her terminal illness at home. He wanted to offer similar care to relieve the suffering of poor persons unable to afford private nurses.

Public health nursing

aka plation centered nursing is a product of various social, economic, and political forces; it incorporates public health science in addition to nursing science and practice.

Nightingale

considered the founder of modern nursing. After limited formal training in nursing in germany and paris, she became superintendent in 1853 of a small hospital in london. Her outstanding success in reorganizing the hospital led the british government to request that she head a mission to the crimea, where britain was fighting a war with russia. After her return to england in 1856, she wrote notes on hospitals and notes on nursing and founded a training school for nurses at st. Thomas' hospital, where she attracted well-educated

5 ftn of family

economic, reproduction, socialization, affective and healthcare

Family developmental and life cycle theory

emphasizes how families change over time and focuses on interactions and relationships among family members.

Lillian Wald

established the Henry Street Settlement, which became the Visiting Nurse Service of New York City, in 1893. She played a key role in innovations that shaped public health nursing in its first decades, including school nursing, insurance payment for nursing, national organization for public health nurses, and the United States Children's Bureau. Founded in 1902 with the vision and support of Lillian Wald, school nursing sought to keep children in school so that they could learn.

systems theory describes family

families as a unit of the whole composed of members whose interactional patterns are the families as a unit of the whole composed of members whose interactional patterns are the

4 approaches to viewing family

family as context, family as client, family as a system, and family as a component of society.

goal of family nursing

focus care, interventions, and services to optimize the self-care capabilities of families and to achieve the best possible outcomes.

Bioecological family theory

helps community/public health nurses identify the stressors and potential resources that can affect family adaptation.= macro, micro, meso

historical approach

used to increase understanding of public health nursing in the past, as well as its current dilemmas and future challenges. • The history of public health nursing can be characterized by change in specific focus of the specialty but continuity in approach and style of the practice.