Community Health Lecture Part 1

7/29/2019 Community Health Lecture Part 1

http://slidepdf.com/reader/full/community-health-lecture-part-1 1/66

Mary Ann Rosa MSN, RN, CS, GNP

Queensborough Community College

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Part I

Introduction and Overview of

Community Health Nursing



Historical Perspective

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First written reference to care of the ill at home is found in the New Testament

Florence Nightingale, 1860s

Opened the Nightingale School of Nursing in 1860 where she stressed goodfood, clean air and sanitation

One year of training: promoting self-care and the health of the communities Also involved in developing nursing for the sick poor at home and in

workhouses

Origin of the concept of “ visiting nurse”

District public health nursing. Each nurse was assigned a specific geographicarea of London

William Rathbone:

Promoted the establishment of district nursing

Modern concept of “visiting nurse”




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Founder of Public Health Nursing

The number of poor immigrants who had come to

America from Europe with little resources

Lived in communities on the lower east side of Manhattan

Resided in tenements

Developed many illnesses

.

Lillian Wald




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Lillian Wald continued: Visiting Nurse Service founded by Lillian Wald and Mary

Brewster in 1893. Venture was funded entirely through private donations Started with a focus on MCH

Henry Street Settlement House, 1895 Founded by Lillian Wald; help by Mary Brewster Nurses lived in the neighborhoods where they worked

Coined the term “Public Health Nurse” Lillian Wald defined public health nursing as seeking to

cure the sick patients as well as trying to alleviate theunderlying cause of disease by improving healtheducation and public health standards.




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1910: approx. 90% of all nursing care was provided inthe home

Shift to the Hospital after World War I

Technology and complexity Increased Access to Health Insurance An Aging Population and Increased health care

needs Injuries from war

Development of private insurance & Medicare &Medicaid




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Shift Back to the Community in the 1980s

Escalating Health Care Costs




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Rising Health Care Costs in the 1980s

Overuse of expensive care & procedures

Failure to promote preventive services

Increased number of uninsured people Higher insurance rates for those that can pay

Increased Health Care Salaries




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Rising Health Care Costs in the 1980s continued: Aging Population

Survival of patients with complex problems

Expensive, sometimes, unnecessary tests – covered by

insurance Defensive Medicine

Long Hospital Stays



1980s begins the start of

Cost Containment

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The Tax Equity and Fiscal Responsibility Act

(TEFRA) in 1982

1983 Social Security Amendments

Prospective Payment System (PPS)

Diagnosis Related Groups (DRGs) for

reimbursement

Development of PPOs, HMOs, and managed



Managed Care

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Through the use of responsible,

effective, and cost-efficient care,Managed care refers to a system

that for a set fee, assumes

responsibility and accountability for the health of a population



1980s begins the start of

Cost Containment

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LOS decreased

Discharged “quicker and sicker”

Increased need for services in the community

Movement of nursing care back to community



erence e ween osp aCommunity

Factors Hospital CommunityIllness

Environment

Resources

Access to Patient

Focus

Family support

Client Role

Nursing Role

Teaching style of nurseMRosa



Community Based Nursing

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Nursing care directed toward specific individualsand families within a community

Philosophy of care – how the nurse practices, notwhere the nurse practices



Community Based Nursing

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Assists patients as they move among and

between health care settings

The individual & family have primary

responsibility for decisions The patient is viewed within the family and social

systems

Illness is a part of life

Purpose of care is to limit disability, improve

functional capacity and QOL

Treatment effectiveness drives decisions



Community Health Nursing

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Subset of community based nursing

Requires specific knowledge and skill

Care provided for individuals, families, and

groups within a community

CHN defined by its role in promoting public’s

health



NLN

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NLN recommends that all nursing education preparenurses to function in community based settings.

To also understand the business of health care

To have highly developed skills – assessment,interdisciplinary collaboration & working withculturally diverse populations



National League for Nursing’s Essential

Components of Community Care

Self-care

Advance Directives

Living Will

Management of Illness

Prevention

Consideration of family, culture, and

community

Continuity of care through Collaboration

Essential for quality care



Continuity of Care

Coordination of activities involving clients, providers,

and payers to promote the delivery of heath care



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



Critical Thinking Exercises

CONTINUITY OF CARE

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1. List three examples from your clinicalexperience where you believe continuity was interrupted.

2. Indicate the steps that could have been takento ensure continuity of care in these examples.

3. Recall three examples from your clinicalexperience where continuity of care was evident.

ommun y ase urs ng s



ommun y ase urs ng sCompetencies

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Assessment & Physical Caregiving

Critical Thinking & Problem Solving

Learner / Teacher

Management

Documentation

Communication

Culturally Sensitive Care

Being an advocate

ommun y ase urs ng s



ommun y ase urs ng sCompetencies

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Interdisciplinary Care

Partner with communities

Improve access to care

Understanding Primary Care / Disease Management

Preventative Care

Evidenced Based Practice

Information Technology

Leadership Performance Improvement

Ethical – Legal



Health Promotion & Disease

Prevention

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Health Promotion

Disease Prevention

Health Protection



Levels of Prevention

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Primary Prevention

prevention of initial occurrence of disease or injury

Includes Health Promotion & Health Protection

Secondary Prevention

Early identification of disease / injury with intervention to

limit disability

Tertiary Prevention

Limit disease progress / disability



Match each activity with the appropriate

level of prevention

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Immunizations

Physical assessment

HTN screening

Teaching re: lifestyle changes such as diet

Smoking cessation

Mammography

Support groups for caregiver

Meals on Wheels for homebound

Seat belts

Pregnancy testing

Alcohol & drug prevention

PT after stroke

Mental health counseling for rape victims

Home management after chronic illness

Hygiene teaching



Prevention in Different Settings to

Individuals, Families, Groups &

Communities

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Examples of _________________ Prevention

Counseling and HIV testing to individual

Early prenatal care

TB screening for a family at risk

Lead screening of children in a community





Communities

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Nutrition teaching to the patient with AIDS Teaching to a newly diagnosed patient with

diabetes about diet Teaching to a family member about how to

follow procedure for a dressing change Support group for children with asthma

Shelters for victims of natural disasters





Communities

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Family planning to an individual in the clinic

education about infection control in the home

prenatal classes to a group of pregnant

adolescents fluoride water supplementation to the

community



Goals of Prevention

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Improve Quality of Life

Be Cost Effective



Screening Identifies individuals with unrecognized health

risk factors or asymptomatic disease

conditions in populations



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



Question

Which public health nursing intervention is seenin the following example?

Student nurses go into a neighborhood door-to-

door. They identify individuals who have not

had flu shots and direct them to the local

community center’s flu clinics.

A. Screening

B. Outreach

C. Health teaching



Question

Which public health nursing intervention is seen

in the following example?

A group of student nurses takes blood

pressures at a senior center in the communityand provides information about hypertension,

what follow-up those with high blood pressure

require, and how they may secure health

care.

A. Screening

B. Health education

C. Outreach



Question

Which public health nursing intervention is seenin the following example? A nurse and a physical therapist meet to plan

the care of an elderly woman who ishospitalized with a broken hip and will bedischarged from the hospital today.

A. CollaborationB. ConsultationC. Care management



Question

Which public health nursing intervention is seenin the following example?

A nurse meets with Edna, an elderly womanwho has been hospitalized with a broken hip,

and her family. They discuss what self-careEdna can manage on her own and how thefamily may be able to assist her once shegoes home, and determine the communityresources available to assist with her care.

A. Health teachingB. Case managementC. Collaboration



Infant Mortality

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Death Rate of infants < 1 year per 1000 births

An international measure of health status

US Infant Mortality Rate = 6.9

International Ranking = 27



Infant Mortality

Leading Causes of Infant Death

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Congenital ailments

Pre-term / LBW

Sudden Infant Death Syndrome

Problems Due to Pregnancy

Respiratory Distress Syndrome



The Community

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Group of people with common characteristics Geographic

Political

Race / Ethnicity

Age

Problem Based

Knowledge of the community increases qualitycare

What makes a healthy community?



The Community & Health,

Health Care Needs Influenced by:

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Vital Statistics & Demographics

Resources & Support Services

Community Leadership

Culture

Composition of Families

Socioeconomic Status Community Boundaries

Social Systems

Social Systems & Health in the



Social Systems & Health in the

Community

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Economy

Education

Religion

Welfare

Recreation

Health Care

Government



Health

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Defined by the World Health Organization as

“a state of physical, mental & social well-

being and not merely absence of diseases”

Health Illness Continuum

Continuum from optimal health

to total disability



What is Health?

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Acute CareNursing Focus

Fix the problem

Eliminate disease

Community NursingFocus

Facilitate Self Care

Improve functional ability

Enhance QOL



Healthy People 2020

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Provide information & knowledge about how toimprove health in a format that enables diversegroups to work together

Provides science-based, 10-year national objectives

for improving the health of all Americans; Frameworkfor improving health of nation.

Road map to better health for all

Can be used by many different people, communities,groups, professional organizations whose concern isa particular population or threat to health



Healthy People 2020

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The Office of Disease Prevention & Health Promotion

U.S. Department of Health and Human Services

coordinates

Healthy People 2020

www.health.gov/healthypeople

1-800-367-4725



Healthy People 2020

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Vision

A society in which all people live long, healthy

lives.

Mission: Healthy People 2020 strives to:

Identify nationwide health improvement

priorities.

Increase public awareness and understanding Provide measurable objectives and goals

Engage multiple sectors

Utilize evidence based practice

D t i t f H lth



Determinants of Health

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What makes some people healthy and othersunhealthy?

How can we create a society in which everyone

has a chance to live long healthy lives?



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Healthy People 2020

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Addressing “All Hazards” Preparedness as aPublic Health Issue

The Role of Health Information Technology and

Health Communication



What Does Healthy People 2020

Say About Cultural Care?

Elimination of disparity among groups in access to

quality health care

Increase in community-based programs that areculturally and linguistically appropriate

Healthy People 2020: Focus



Healthy People 2020: FocusAreas

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1. Access to Quality Health Services

2. Arthritis, Osteoporosis, and Chronic Back Conditions

3. Cancer

4. Chronic Kidney Disease

5. Diabetes

6. Disability and Secondary Conditions

7. Educational and Community-Based Programs 8. Environmental Health

9. Family Planning

10. Food Safety

11. Health Communication12. Heart Disease and Stroke

13. Immunization and Infectious Diseases

14. HIV





Areas

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15. Injury and Violence Prevention

16. Maternal, Infant, and Child Health

17. Medical Product Safety

18. Mental Health and Mental Disorders

19. Nutrition and Overweight

20. Occupational Safety and Health 21. Oral Health

22. Physical Activity and Fitness

23. Public Health Infrastructure

24. Respiratory Diseases 25. Sexually Transmitted Diseases

26. Substance Abuse

27. Tobacco Use

28. Vision and Hearing



Healthy People 2020

Eliminate Health Disparities

Examples of Health Disparities

Effect of income on

health status

The lower the household

income, the poorer thehealth

Effect of education on

income

The higher the education,

the more income

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Question

What can nurses do to address disparity in their own

community?

A. Educate themselves regarding issues of disparity

B. Use evidence-based decision making

C. Identify vulnerable populations in their communitiesD. Advocate for vulnerable populations

E. All of the above



Healthy People 2020

Increase Quality & Years of Healthy Life

Life Expectancy at Birth, 1930 –2002National Center for Health Statistics, National Vital Statistics Reports, vol. 52, no. 3

2002 77.3

2000 77.0

1995 75.8

1990 75.4

1980 73.7

1970 70.8

1960 69.7

1930 59.7MRosa

C St d 1



Case Study 1

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. Harold is a 61-year-old bachelor who lives alone on a

farm in a rural area. His diabetes has been wellcontrolled for 40 years. Harold had lived with hismother, who cooked for him and administered hisinsulin. After his mother’s death last year, he went to theclinic three times in 3 months for problems with his

diabetes. Harold stated, “Every time I went to the clinic Isaw someone different. I would tell them the same storythree times. Don’t they ever talk to each other?” He wasadmitted for a large ulcer on his ankle and uncontrolleddiabetes last week.



Case Study 1 continued

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This morning you interviewed him in preparation for hisdischarge. He told you that he has never cooked anddoesn’t plan to learn now. He would rather go to thebakery and get doughnuts and caramel rolls for breakfast and lunch and eat cake and ice cream for dinner. He has refused to participate in any care

related to his wound or even look at his wound.Harold seems very attached to his niece, who lives ona farm half a mile from him. She visits him everyevening and has offered to help with his care. Your first plan was to have a home health aide provide

homemaking care for Harold. When you suggestedthis he said, “No one is going to come into my houseand cook in my mother’s kitchen! That’s what family isfor!”



Case Study 1

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a. What are the problems identified?1. Physical

2. Psychosocial

3. Family dynamics

4. Environmental5. Lifestyle



Case Study 1

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b. How will you use the elements of community based

nursing to plan for Harold’s discharge?

• self -care

• in the context of the family and community

• preventive focus

• continuity



Case Study 1

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c. List one goal for each problem identified.1. Physical

2. Psychosocial

3. Family dynamics

4. Environmental5. Lifestyle



Case Study 1

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d. What nursing actions would you take to help

achieve these goals?

e. Specify community resources you can suggest to

this client.



Case Study 2

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Anna is 85 years old and suffers from congestive heart

failure. She is not taking her medication. Her

hemoglobin is 9.0 g/dL and she complains about

constant fatigue. Her weight has remained

constant, but she states “my legs have gotten so

swollen and I am so short of breath.”

a. Determine the primary nursing role.

b. State two likely basic or physical needs and

psychosocial needs

Case Study 3



Case Study 3

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Mrs. Nguyen is a 45-year-old woman admitted to the hospital for

spinal fusion of C5-6 & C6-7 vertebrae. She is from Vietnam &has lived in the U.S. for 15 years. She has been suffering from

degenerative disk disease & osteoarthritis for the last 4 years & has lost

some of the function in her right arm. Her plan of care was developed

around the critical pathways for cervical fusion, with an expected length

of stay in the hospital from 3 to 5 days. The surgical procedure wasuneventful, but Mrs. Nguyen suffered from nausea & vomiting until the

middle of postoperative day (POD) 1. Today is POD 2. She is able to get

to the bathroom by herself but cannot dress herself, bathe herself, or

pick up anything weighing over 3 or 4 lb. Her physician is

recommending that she be discharged tomorrow, POD 3. She will be in aPhiladelphia collar for 6 weeks, during which time she will be unable to

drive. Mrs. Nguyen lives with her husband & 2 teenage sons, ages 14 &

16. Her husband owns a restaurant & works 12 to 14 hours a day. He will

not be taking off any work time to care for her when she gets home.



Question

Who said the nurse, through her “peculiar introduction to the patient and her organic

relationship with the neighborhood” could be the

“starting point” for wider service in the

community? A. Mary Brewster

B. William Rathbone

C. Lillian WaldD. Florence Nightingale



The Principles of Community Care

Advocating self-care

Focusing on prevention

Family, culture, and community

Health and Social Systems are interactive

Continuity of care

Collaborative care

Community Health Lecture Part 1

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Transcript of Community Health Lecture Part 1