Health: A Community View

Chapter 1

Health: A Community View

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Community/Public Health Nursing …

… is the synthesis of nursing practice and public health practice.

… has the major goal to preserve the health of the community and surrounding populations.

… focuses on health promotion and health maintenance.

… is associated with health and identification of populations at risk rather than an episodic response to patient demand.

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The mission of public health is …

… social justice, which entitles all people to basic necessities such as adequate income and health protection and accepts collective burdens to make this possible.

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http://www.health.gov/phfunctions/public.htm

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How Do We Define Health?

A state of complete well-being, physical, social, and mental, and not merely the absence of disease or infirmity.

– World Health Organization, 1958

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, therefore, 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.

– World Health Organization, 1986

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Community …

… a group or collection of locality-based individuals, interacting in social units and sharing common interests, characteristics, values, and/or goals.

Nies and McEwen, 2013

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Figure 1-2

From U.S. Department of Health and Human Services Office of Disease Prevention and Health Promotion. Federal Interagency Workgroup: The vision, mission, and goals of Healthy People 2020. http://www.healthypeople.gov/2020/Consortium/HP2020Framework.pdf. Accessed July 2013.

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Healthy People 2020 Leading Health Indicators

Access to Health Services

Clinical Preventive Services

Environmental Quality

Injury and Violence

Maternal, Infant, and Child Health

Mental Health

Nutrition, Physical Activity, and Obesity

Oral Health

Reproductive and Sexual Health

Social Determinants

Substance Abuse

Tobacco Use

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Public and Community Health

Public health is the Science and Art of …

(1) preventing disease,

(2) prolonging life, and

(3) promoting health and efficiency through organized community effort…

C.E. Winslow…

Community health extends the realm of public health …

…to include organized health efforts at the community level through both government and private efforts.

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Core Public Health Functions

Assessment: Regular collection, analysis, and information sharing about health conditions, risks, and resources in a community.

Policy development: Use of information gathered during assessment to develop local and state health policies and to direct resources toward those policies.

Assurance: Focuses on the availability of necessary heath services throughout the community. It includes maintaining the ability of both public health agencies and private providers to manage day-to-day operations and the capacity to respond to critical situations and emergencies.

– Institute of Medicine (1988)

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10 Essential Services

Assessment

Monitor health status to identify community health problems.

Diagnose and investigate health problems and health hazards in the community.

Research for new insights and innovative solutions to health problems.

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10 Essential Services (Cont.)

Policy Development

Inform, educate, and empower people about health issues.

Mobilize community partnerships to identify and solve health problems.

Develop policies and plans that support individual and community health efforts.

Research for new insights and innovative solutions to health problems.

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10 Essential Services (Cont.)

Assurance

Enforce laws and regulations that protect health and ensure safety.

Link people to needed personal health services and ensure the provision of health care when otherwise unavailable.

Ensure a competent public health and personal health care workforce.

Evaluate effectiveness, accessibility, and quality of personal and population-based health services.

Research for new insights and innovative solutions to health problems.

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The Three Levels of Prevention

Primary prevention

Prevention of problems before they occur

Health promotion and health protection

Secondary prevention

Early detection and intervention

Early diagnosis and treatment

Tertiary prevention

Correction and prevention of deterioration of a disease state

Limitation of disability and rehabilitation

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The Three Levels of Prevention (Cont.)

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Figure 1-2

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Level of Prevention—Individual

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Level of Prevention—Family

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Level of Prevention—Group

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Level of Prevention—Community

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Healthy People 2020

Vision

A society in which all people live long, healthy lives.

Overarching Goals

Attain high-quality, longer lives free of preventable disease, disability, injury, and premature death.

Achieve health equity, eliminate disparities, and improve the health of all groups.

Create social and physical environments that promote good health for all.

Promote quality of life, healthy development, and healthy behaviors across all life stages.

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Healthy People 2020 (Cont.)

HP2020 has 42 focus areas

The objectives and related information and materials can help guide health promotion activities and can be used to aid in community-wide initiatives.

(USDHHS, 2013)

All health care practitioners…

should focus on the relevant areas in their practice

incorporate objectives into programs, events, and publications whenever possible

use them as a framework to promote healthy cities and communities

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Healthy People 2020 Topic Areas

Access to Quality Health Services

Adolescent Health New

Arthritis, Osteoporosis and Chronic Back Conditions

Blood Disorders and Blood Safety New

Cancer

Chronic Kidney Disease

Dementias, including Alzheimer’s Disease New

Diabetes

Disability and Secondary Conditions

Early and Middle Childhood

Educational and Community-based Programs

Environmental Health

Family Planning

Food Safety

Genomics New

Global Health New

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Healthy People 2020 Topic Areas (Cont.)

Health Communication and Health Information Technology

Healthcare-Associated Infections New

Health-Related Quality of Life and Well-Being New

Hearing and Other Sensory or Communication Disorders

Heart Disease and Stroke

HIV

Immunization and Infectious Diseases

Injury and Violence Prevention

Lesbian, Gay, Bisexual, and Transgender

Health New

Maternal, Infant, and Child Health

Medical Product Safety

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Healthy People 2020 Topic Areas (Cont.)

Mental Health and Mental Disorders

Nutrition and Weight Status

Occupational Safety and Health

Older Health New

Oral Health

Physical Activity

Preparedness New

Public Health Infrastructure

Respiratory Disease

Sexually Transmitted Diseases

Sleep Health New

Social Determinants of Health New

Substance Abuse

Tobacco Use

Vision

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Public Health Nursing

ANA definition (2007)

The practice of promoting and protecting the health of populations

Uses knowledge from nursing, as well as social and public health sciences, to promote and protect the health of populations.

Is population focused, with the goals of promoting health and preventing disease and disability for all people

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Community Health Nursing

ANA definition (1980)

Synthesis of nursing practice and public health to promote and preserve the health of populations

Care is directed to individuals, families, groups

Contributes to health of the total population

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*The terms Public Health Nursing and Community Health Nursing are used interchangeably in Nies and McEwen, 6th edition.

Community-Based Nursing

“Application of the nursing process in caring for individuals, families and groups where they live, work or go to school or as they move through the health care system”

–McEwen and Pullis, 2009

Setting-specific

Emphasis is on acute and chronic care

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Community and Public Health Nursing Practice

Nurses practice disease prevention and health promotion

Practice is collaborative

Practice is based on research and theory

Applies the nursing process to the care of…

Individuals

Families

Aggregates

The community

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Population-Focused Nursing

Focuses on the entire population

Is based on assessment of the population’s health status

Considers the broad determinants of health

Emphasizes all levels of prevention

Intervenes with communities, systems, individuals, and families

– Minnesota Department of Health, 2003

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PHN Intervention Wheel

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Figure 1-3

Illustration from Minnesota Dept. of Health Center for Public Health Nursing.

Is population based

Contains three levels of practice (individual, community, and system)

Identifies 17 public health interventions

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Public Health Interventions (purple section)

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 to the health of populations, ascertains the source of the threat, identifies cases and others at risk, and determines control measures.

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Public Health Interventions (purple section) (Cont.)

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

Screening: Identifies individuals with unrecognized health risk factors or asymptomatic disease conditions in populations.

Case finding: Locates individuals and families with identified risk factors and connects them with resources.

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Public Health Interventions (green section)

Referral and follow-up: Helps individuals, families, groups, organizations, and/or communities identify and access necessary resources to prevent or resolve problems or concerns.

Case management: Optimizes self-care capabilities of individuals and families and the capacity of systems and communities to coordinate and provide services.

Delegated functions: Direct care tasks a registered professional nurse carries out under the authority of a health care practitioner as allowed by law.

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Public Health Interventions (blue section)

Health teaching: Communicates facts, ideas, and skills that change knowledge, attitudes, values, beliefs, behaviors, and practices of individuals, families, systems, and/or communities.

Counseling: Establishes an interpersonal relationship intended to increase or enhance capacity for self-care and coping with a community, system, and family or individual.

Consultation: Seeks information and generates optional solutions to perceived problems or issues through interactive problem-solving with a community, system, and family or individual.

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Public Health Interventions (red section)

Collaboration: Commits two or more persons or organizations to achieve a common goal through enhancing the capacity of one or more of the members to promote and protect health.

Coalition building: Promotes and develops alliances among organizations or constituencies for a common purpose.

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

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Public Health Interventions (yellow section)

Advocacy: Plead someone’s cause or act on someone’s behalf, with focus on developing the capacity of the community, system, and individual or family to plead their own cause or act on their own behalf.

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.

Policy development and enforcement: Places health issues on decision-makers’ agendas, acquires a plan of resolution, and determines needed resources, resulting in laws, rules, regulations, ordinances, and policies. Policy enforcement compels others to comply with laws, rules, regulations, ordinances, and policies.

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Providing population-based care… a shift in thinking

Populations are not homogeneous; must address the needs of special subpopulations.

High-risk and vulnerable subpopulations must be identified early in the care delivery cycle.

Nonusers of services often become high-cost users; essential to develop outreach strategies.

Quality and cost of all health care services are linked together across the health care continuum.

(Kaiser Family Foundation, 2013)

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