Chapter 42 Community Nursing – Flashcards

Nurses working in the community and public health regularly deal with concerns about communicable disease and immunizations programs to prevent them.

...

The word community comes from the Latin term communis, meaning the gift of fellowship of common relations and feelings. Historically it meant a body of like minded people or the inhaitatns of town. Then and now the general term suggests a general sense of selflessnes, sharing, relationship, and doing good that comes from working together.

This is defined as all of the people inhabitating a specific area. Ex: look at the map of Ohio and try to determine the approximate boundries of the city of Dayton. To accurately determine the boundries of the city , you would need local maps showing exact roads, streets, rivers, and other landmarks. As you can imagine, the characteristics and concerns of many people living wihtin Dayton var;y greatly.. There are many communities within the city of Dayton.

This conducts a survey and count of the American people every 10 years. the most recent was conducted in 2010, for results according to the density of population.

In urban areas, a census tract covers a small area. Rural census tracts are large.

These are useful to public officials , market analysts, and anyone, including community nurses who studies the characteristics and concerns of smaller sections of people.

These show the feopolitical boudries of a community. But as we noted earlier, a community can also be a group of people with a common purpose.

This is a group of people with at least one shared characteristic, either personal or environmental. Ex: a community health nurse may work with a class of high school girls to reduce incidence of adolecent pregnancy. The shared characteristic of this aggregate is that they are female, of child-bearing age, and attend a particular school. Ex: The nursing students in your school are an aggregate. What characteristics or goals do you share?

To understand a particular community and its needs, you will need information about its three components: 1.Structure 2.Status 3. Processes

This refers to the general characteristics of a community. These include demographic data such as: 1. Age 2.Gender 3.Ethnicity 4. Education 5.Income levels

This describes the biological,emotional, and social outcome componenets of a community.

This type of data include: -morbidity(illness) -mortality(death rates) -Life expectancy ratios -Risk factor profiles for the respective age groups within a community.

These data include general indications of mental health and consumer satisfaction survey results about various aspects of the community as compared to other locales.

This type of data include crime rates, citizenship involvelment in community wide activities, and general functional levels of the community members.

This describes the overall effectiveness level of the community. Ex:Do the members of the community perceive that they are part of a group with common interests? What is the extent of the interaction among community members? Does the community have an established forum for conflict resolution?

As with individuals, the meaning and perception of health varies among aggregates. For nurses, it is important to understand what a particular community defines as health rather than relying on personal definitions

Health is whatever the client community defines it to be.

When determining what makes a community healthy, the national consensus paper healthy people 2020 provides useful guidelines.

Healthy people 2020 identifies leading indicators for measuring the health of our nation. Some examples include: -Physical activity -Overweight and obesity -Tobacco use -Substance abuse -Responsible sexual behavior -Mental Health -Injury and violence -Environmental quality - Immunizations -Access to healthcare

1. Increase years of healthy life 2.eliminate health disparities among different populations, including accessibility to healthcare. 3.Create an environment conducive to social and physical health 4. Promote healthy living for people across all life stages

...

A vulnerable population is defined as an aggregate that is at increased risk of adverse health outcomes.

Members of vulnerable populations have a higher probability of developing illness than do members of the general population Ex: Pregnant adolescents are more likely to develop complications than pregnant women of all ages taken as a whole. Because of their increased risk of health problems, vulnerable populations are a major focus of community health efforts.

Vulnerability involves multiple factors: 1. Limited resources 2. Limited Social resources 3.Age 4. Chronic disease and obesity 5. History of abuse and trauma

Income is a major predictor of health risk. People with higher incomes typically have greater access to health services and greater selection of providers, treatment options, and location of health services. In contrast, the more limited a person's income, the more limited their health options. Consequently, many persons of low income forego preventive or health maintenance care and seek healthcare services only when they are quite ill.

Freinds and family are valuable resources to help a person deal with day to day stress as well as demands associated with illness. They provide feedback, listen to concerns, and offer emotional and physical assistance. Unfortunately, not everyone has social resources. *****Older adults who live alone and people with mental illness are examples of groups at increased risk because of social isolation.

The very young and very old are less able to adapt to physiological stress and are at increased risk of disease. They are more prone to infections and may not be able to protect themselves from environmental hazards, such as cold or heat. These age groups are also more likely to be living in poverty.

People who have chronic disease are at greater risk for many health problems. Ex: People with obesity are at increased risk for heart disease, diabetes, impaired mobility, joint pain, and other complications. People with diabetes are at risk for blindness, impaired wound healing, and other complications.

People who have experienced abuse or traumatic events often feel they have limited control over their health and circumstances. They may experience powerlessness and hopelessness and are not able to initiate activities that promote health and lead to early treatment of illness. Their circumstances also tax their reserves and place them at a risk for mental health problems. Other vulnerable populations include: -People who are poor or homeless -migrant workers -people with disabilities -premature infants -Women with high risk pregnancy -pregnant adolescents -people with communicable disease -people who abuse substances -Members of certain ethnic/racial groups -untreated mentally ill

A community can either be a site for healthcare delivery or a recipient of healthcare services

-Complimentary care -Alternative care

This type of care refers to acute care or rehabilitative services performed in clinics, offices, mobile care units, and other facilities in the community, rather than in acute care settings, such as hospitals. Ex: Many surgeries and diagnostic procedures are performed in surgicenters, clinics, and physicians offices rather than in hospitals. People also receive mental, physical, cardiac, and pulmonary rehabilitation services in outpatient settings. Extended care facilities, or nursing homes, commonly provide rehabilitive care for patients after acute traumatic injuries, as well as continuous skilled care for older adults and people with chronic illness. The following sections describes three approaches to community-based nursing care: 1. Community health nursing 2.Public health nursing 3.Community oriented nursing.

This type of nursing focuses on how health of individuals, families, and groups, affect the community as a whole. Community health nurses strive to promote, protect, preserve, and maintain the health of the population thorugh delivery of personal health services to individuals, families and groups. Ex: A community health nurse may work in a prenatal clinic providing free services for low-health income women. The nurse provides a direct service, to each pregnant woman, yet she is doing that to improve the general health of the entire community. By encouraging the mother to eat balanced meals, exercise, avoid harmful substances, the nurse improves the general health of the entire community. By and avoid harmful substances, the nurse improves the health of both mother and baby- who are members of the community and , therefore,improves the overall health of the community.

This type of nursing focused on the community at large and the eventual effect of the community's health status on the health of individuals, families and groups.

The goal of public health is to prevent individual disease and disability, in addition to promoting and protecting the health of the community as a whole. Ex: A public health nurse may be employed by a county health department to provide tuberculosis surveillance services. The nurse helps to protect the entire community by screeening for TB at the local school, by testing high risk individuals for TB, and by identifying and tracking clients with active disease to ensure that they complete the prescribed 6 to 9 month medication regimen.

Because public health focuses on large-scale programs that address the entire community, government based agencies often provide these services. The united States Public Health Service is an example of a public health agency based within the federal governement

This type of nursing combines componenets of community and public health, focusing on health promotion, illness prevention, early detection, and treatment provided within the community setting. The practice is evidence based and collaborative with other community health disciplines. The focus is a comprehensive look at the individual, family, group and community at large. EX: A nurse with a community-oriented approach might work in a comprhensive adolescent prenatal program. The nurse provides individual care at the local clinic 2 days per week. While at the clinic, she gathers data adolescent clients about the schools they attend;their knowledge of birth control,pregnancy and childbirth;as well as the issues these girls face with pregnancy. On the remaining three days of the week , she engages in the community focused activities that are informed by her knowledge and experience with pregnant teens. Ex: She meets with school officials to identify pregnant teens who need prenatal care, teaches a class about sexuality ion the local high school, works with teachers to identify strategies to keep pregnant teens in school, provides parenting education to adolescents who have children and advocates changing a bus route so that teens can easily get to the local clinic. Each aspect of care allows the nurse to gather more data about the needs of the individuals and the community as a whole.

Florence Nightengale Lillian Wald Clara Barton Margaret Sanger

She established the importance of promoting health by manipulating the environment (light,warmth,sanitation,cleanliness) and nursing the whole person

She was known as the first community health nurse;founded the visiting nurses association in New York

She was the founder of the American Red Cross

She was the founder of the international Planed Parenthood federation. She pioneered the use of family planning and birth control education.

...

This is one of the most effective nursing intervention. It involves assisting the client (individual, community) to recognize and use available resources to acheive or maintain the desired level of health, achieve autonomy, and maintain positive self-esteem.

Community health nurses function as client advocates, educators,counselors,collaborators,and case managers.

A community health nurse consistently supports the identified or expressed concerns of the client and/or community. This often requires political involvement at the local, state, and national levels. The challenge is in knowing who to approach for political support. As a community health nurse you can get involved and effect change by joining the local student nurses association,professioanl nursing nursing organizations, school boards, citizen committees, or attending council meetings.

Because community nursing focuses on wellness and disease prevention, much of what the nurse does involves client education of individuals,aggregates at risk of disease, politicians, or a community at large. It is difficult to evaluate the effect of the education because people may not act on the knowledge for months or years after the teaching moment. **When planning teaching you must be aware of the stage of development,educational level, and learning style of the community group you intend to educate. the best learning programs are short;provide relevent,practical information; and can be easily incorporated into the learners daily routine.

A primary task of a community health nurse is to serve as a collaborator. Partnerships and coalitions can effectively address common concerns among different communities. Ex: A Community health nurse is concerned about poor compliance with recommended imunization schedules for 2 year olds in a particular community. He surveys some of the parents to determine their reasons for not obtaining vacations. Teh nurse discovers that the clinic's operating hours are linited and the automated call routing system is frustrating for people trying to schedule an appointment. The nurse also discovers that some offices are not remindin clients to return for missed appointmenrts. The community nurse schedules a meeting of clinical staff,practice managers,and patients to resolve theses issues. At the meeting some larger issues are revealed, such as failure of state medicaid agencies to reimburse the providers adequately and in atimely manner. In addition, there are not enough medicaid providers to serve the community.

Once you have established rapport with a group, members may consult you about a variety of health and non-health related concerns. you must be careful to offer council only in areas within your scope of practice and make recommendations that are practical yet meet the needs of the community. often, you may need only to serve as a witness to the group's concerns. Letting clients debate or work through issues empowers them and fosters self-resilience.

Community nurses commonly make referrals to or collaborate with orther health and social agencies. Be cautious in referring clients to these resources, because agency policies and financing change frequently. also, because commhnity agencies often operate on grants and time restricted funding, a program that is available at one time may be dissolved at another. As a nurse you will need to remain in contact with agencies to which clients are referred so that you remain aware fo the current restrictions and availablitity of services. Ex: a local group has established a free healthcare program for resident children who are underinsured. Pediatricians and nurses volunteer their time to provide the care. Pharmaceutical representatives provide the medical supplies and routine medications. Local specialists(surgeons) provide services to those with complex orspecialized needs. However, in such a clinic,the appointment times fill up quickly, and often clients have to wait more than a moth or two for an appointment. Before enrolling families in the program, you need to be aware of these limitations and share this information with clients.

There are three basic levels of care in which nursing interventions can be classified: 1.Primary 2.Secondary 3.Tertiary

The goal of these type of interventions is to promote health and prevent disease. Educating susceptible individuals with no known disease process is an example of a routine, primary intervention that communit health nurses practice. Ex: a nurse may educate high school freshman girls about the risk of hepatitis B and human papilloma virus, the benefits of vaccination, and strategies to reduce the likelihood of exposure to contaminated body fluids. Other Ex: Include collaborating with local agencies to provide clean and secure temporary housing fo migrant farm workers, and lobbying elected representatives for a ban on smoking in restaurants. ***Primary interventions are usually the least invasive and least expensive of the three levels of intervention.

***Primary interventions are usually the least invasive and least expensive of the three levels of intervention.

Seconday(second-level)interventions aim to reduce the impact of the disease process by early detection and treatment. Ex: a community health nurse may screen a sexually active little girl for hepatitis B and or HPV. She has known risk factors for sexually transmitted infection but no apparent disease symptoms. The nurse will also teach the client how to protect herself form sexually transmitted infections. hepatitis B, and HIV in the future. Other Examples of seconday interventions include; -Providing outreach screening programs offering mammography, scoliosis screening, lipid testing, or PSA testing for prostate cancer.

The goal of tertiary(third-level0Interventions is to hault disease progression and/or restore client functioning to the pre-disease state. The disease process is clinically apparent and client debilitation, including death is likely without intervention. **these type of interventions are usually the most invasive and require the nurse to collaborate with members or other disciplines to provide treatment. Ex: a student may report to a school nurse that she has been involved in unprotected sexual activities. The school nurse may refer the student to the public health clinic for a pelvic examination and lab testing to detect a sexually transmitted infection and HepB, HPV< and HIV screening. The student has an abnormal pap smear showing cells suggestive of HPVexposure. The nurse, in collaboration with the provider provides medical treatment. There is no cure for HPV, so the teen also needs to learn how to prevent the spread of the disease to others and obtain regualr PAP and Pelvic exams to detect cervical cancer and other STDIs.

**these type of interventions are usually the most invasive and require the nurse to collaborate with members or other disciplines to provide treatment.

1. School nurse 2.Parish nurse 3.Occupational nurse 4.Nursing at correctional facilities 5.Public health clinics 6.Disaster service nursing 7. International nursing 8.

These nurses provide direct care for children with chronic health conditions, such asthma,hyperactivity disorder,and diabetes and for children who need routine procedures, such as catheterization during the school day. They perform a mandated vision and hearing screening. They also administer prescribed medication and ensure that age appropriate immunizations are documented. Some school nurses offer education on topics such as sexual and reproductive health. The nurse may also serve as a role model for students who lack parental support or who are struggling with peer pressure. For the most part, a school nurse is autonomous and must be capable of prioritizing and making decisions

These nurses work primarily in industrial or corporate settings. They provide health teaching for employees and their families in an effort to reduce absentee hours and increase productivity. Few industries still use occupational nurses in this manner. Instead, most employ nurses to fulfill union contracts and to complete required medical documentation for disability claims or occupational hazardous events. Thus the responsibility of the ocuupational health nurse may be limited to performing new hire and annual screenings, providing care to injured workers, completing random drug testing, and filing workers compensationclaims. ***To reduce costs, most large industries hire a staffing agency to provide trained occupational health nurses. Nursing autonomy and responsibility vary with the employer and the negotiated contract.

This is also known as faith community nursing. It is a community-oriented nursing specialty, defined by the American Nurses Association as " the specialized practice of professional nursing that focuses on the intentional care of the spirit as part of the process of promoting holistic health and preventing or minimizing illness in a faith community. the major job activities revolve around integrating faith with health. The parish nurse acts as a health educator, and personal health counselor. She develops support groups, trains of volunteers, and provides community referrals as needed. the level of autonomy and responsibility of parish nurses varies, depending on the faith community setting.

Corrections nurses deliver patient care within the criminal justice system, for example: in juvenile detention, substance abuse treatment facilities, and prisons. I n this environment, the nurse provides primary services to patients of all ages in an unbiased an nonjudgmental manner. The level of nursing automony is high in most correctional or substance rehabilitation facilities. The nurse also commonly performs occupational health duties for facility staff. For personal safety, nurses must meet certain physical requirments and complete special weapons training before working in most correctional facilities.

Many community nurses practice within local and state departments of health, including public health clinics. Services offered by health departments can range form basic to comprehensive, based on financial constraints, such as the tax base of the community. Large cities tend to have many nurses who may specialize in an area, such as immunizations, prenatal health, school health, or epidemiology survey. Smaller communities may have only one full-time nurse providing all services. The autonomy and scope of practice of public health nurses are often limited by the philosophy of the political adminstration and availability of funding.

A disaster is any event inflicting wide spread loss of life and destruction of property. HUMAN-GENERATED DISASTERS might be the result of activities, such as a terrorist attack,war, or use of nuclear energy to cause harm of fear. Technological disasters casue damage or disruption on a large scale (computer systems failure,mass power power outage,explosion, or hazardous substance exposure). Ex: of natural and ecological disasters in clude hurricanes,earthquakes, tsunamis, and floods. Communit oriented nursing emphasizes community assessment and education to prevent consequences in the aftermath of disasters when possible and to reduce the number of casualties when disasters occur. Disasters affect the health status of a community in the following ways: -Lead to premature death, illness or injury -Disrupt healthcare services offered within the community -Cause environmental issues, such as outbreaks fo communicable -disease or food/water borne illness. -Cause shortages o safe food and drinking water -Burden other healthcare systems when displaced populations shift to host community for basic needs of living. If a disaster has been declaired, the nurse may practice in any state under direction of the American Red Cross. "Good Samaritan Laws" protect nurses from liability provided they are performing care on a volunteer basis and in a manner considered reasonable and prudent and in accordance with standard practice. I n large scale disasters, nurses are typically needed to triage care, staff first aid stations, assess casualties, assign priorities for care, administer treatment to stabilize the wounded, facilitate transport to local hospitals, and provide healthcare in temporary shelters.

These nurses typically provide relief services after a natural or man-made disaster. They may also offer health and human aid services through a medical clinic, faith-based mission, orphanage, or other international relief program. This type of nursing requires a high level of autonomy, flexability,ingenuity, depending on community needs and available resources. Commonm problems affecting the health of international communities are related to poor sanitation, contaminated food and water, waste management, limited or dangerous transportation,communicable disease, parasitic infecitons, sultural practices,and linited education. **Nurses working globally commonly treat people with malnutrition,dehydration, mosquito and other insect related illnesses, parasicitc infestation, and HIV.

This should be delivered in a practical, and culturally sensitive manner.

This is usually ongoing and requires the nurse to collaborate and compile information from a variety of sources. The assessment approach is based on the type of community, the purpose of the assessment, and personal preference. Most beginning students elect to assess a geopolitical community because the data are more readily available than data from aggregate groups

Community assessment usually begins with this. -It is performed by observing the community through your automobile window, on foot, or being physically present in the area. It is similar to the general observation of the client in that it provides an overview and allows you to see the commuity in its natural state. As you observe, you make note of the conditon of the buildings and public facilities,residence,religious facilities,streets and sewers,modes of transportation, lighting, outward signs of crimes or violence, pollution, waste disposal, and other signs of well-nbeing of the community. Protective services such as police and fire services should be included. YOu may need to repeat the survey over a period of time, at different times of day,month,or year to get an accurate picture of the community. -Beging to describe the neighborhood and the peopleyou see in the community -Strive to remain objective in your observations. Avoid using personal opinions and prejudices, -for more reliable survey results, observers should be trained -Route your courses prior to conducting the visit -Record your findings as soon as possible. -Document the observation with photographs and videography when possible. -

You can obtain data from these public resources, such as birth records, marriage license, newpapers and community websites. Internet search engines can help you obtain demographic information,morbidity,and mortality data,vital statistics, educational leves,criminal activity, political leadership issues, and or information about community resources.

You will also gather information about how individuals in the community perceive the community and its state of health. Through community forums and informa conversations, you can assess a cross-section of the population. This is not only an important part of your assessment, but also an excellent way to establich rapport,convey your concerns, and develop a work relationship with key community members. Wehn you prepare to intervene in the community, you will find this is time that was wisely spent because community members are more likely to participate in the plan if they are involved from the beginning.

After a thorough assessment, you will analyze the complete set of data and compile a list of community strengths and limitations. In community practice, you need nursing diagnosis that describe the health status of individuals, families,groups and entire communities.

Include three diagnosis that specifically describe the health status of the comunity. 1.Ineffective Community Coping 2.Readiness for enhanced community coping 3.Ineffective management of theraputic regimen:Community The Omaha system was develped specifically for use in community settings. In additions to nursing diagnosis, it contains standardized terminology for outcomes and interventions.

As a Community helath nurse employed by the local health department within the immunization clinic, you have been hired into a new position created by federal and state grant monies to investigate why immunization levels are low among 2 year olds in census tract 15. How owuld you approach the nursing career? 1.Defien the community 2.Learn the community 3.Focus the data collection 4.Analyze the data : Examine the charactersitics of families failing to provide immunizations for children including: -Family demographics -Age of childrem -Number of Imunizations needed and the cost -Beliefs about negitive effects of vaccines -Availability of transportation -Public sites providing vaccinations -Overall continuity of general healthcare for children.