Community Final Exam - Lecture notes 1-10 PDF

Preview

Summary

Download Community Final Exam - Lecture notes 1-10 PDF

Description

 CHAPTER 1: COMMUNITY HEALTH NURSING  Community Health Nursing: - Term that applies to all nurses who work in and with the community in a variety of practice areas such as public health, home health, occupational health - Recognizing that health status is influenced by determinants, such as income, employment, education, gender, race and social environment, CHN aims to improve the health of all persons by addressing these determinants and minimizing health disparities wherever possible - Also consider that lifestyle choices influence health as well (tobacco, alcohol use, drug use, physical activity, sexual practices)  Health Care in Canada: - The Canada Health Act - enacted in 1984 - 5 principles of the Act are: - Universality - Accessibility - Comprehensiveness of services - Portability - Public administration  Population Health and the Determinants of Health: - In traditional health care, the individual is the focus - In population health, the population is the focus and importance is given to the influence of the determinants of health - The aim of a population health approach is to improve the health of the population and reduce health inequalities among groups within the population. A population health approach embraces the full range of protection, prevention and promotion strategies - Traditional health provides treatment for an illness, population health advocates for disease prevention and health promotion - Population focused practice: directs community health nursing practice; in contrast to individual-focused healthcare, it emphasizes reducing the health inequities of a defined population  Social Determinants of Health: - The social conditions and broader forces that interact to influence risks to health and well-being and affect how vulnerable or resilient people are to disease and injury - Community health nurses are continually reminded of how the SDOH can predict the health of populations, and that health public policy includes the SDOH  The 12 Determinants of Health: 1. Income and Social Status: have been shown to be the most important determinants of health 2. Social Support Networks: suggested that poor social relationships may, in fact, be as important a risk factors as smoking or obesity 3. Education and Literacy: health status improves with higher education.

4. Employment/Working Conditions: better economic conditions support health and being gainfully employed provides psychological satisfaction 5. Social Environment: include the support and resources available in the community that helps individuals avoid potential risks to their health 6. Physical Environments: human built environments as well as the pollutants that affect the quality of air, water, food and soil 7. Personal Health Practices and Coping Skills: lifestyle choices and the ability to cope with health outcomes 8. Healthy Child Development: consideration of prenatal and childhood exposures and experiences that may contribute to a variety of chronic conditions and also to the development of physical and emotional outcomes later in life 9. Biology and Genetic Endowment: predisposes some individuals to certain illnesses 10. Health Services: must be accessible to all for health maintenance, promotion, protection, disease prevention, and treatment if population health is to be achieved 11. Gender: indicates that some health problems and health practices are gender specific 12. Culture: may predispose some groups to certain diseases, may also have implications for access to health care services  Ethics: Health inequities: when differences in determinants of health and health status within or between groups are shown to be systematic and avoidable, they are unfair  Equity: - Differences in social status within and between populations have a significant impact on the health status of the larger community within which those differences occur - Inequity disadvantages everyone, not just those living with the least advantages  Social Justice: - The fair distribution of society’s benefits, responsibilities and their consequences. It focuses on the relative position of one social group in relation to others in society as well as on the root cause of disparities and what can be done to eliminate them - Working for social justice involves 2 principles: - Recognizing inequities - Identifying, understanding, and being able to describe inequalities or injustices, the reasons for the presence, and how the affect population subgroups - Taking action to eliminate them - Advocating for the reduction of sources of oppression and working toward parity and fairness  Primary Health Care: - Primary care: refers to the first contact between individuals and the health care system - Usually relates to the curative treatment of the disease, rehabilitation, preventative measures - Primary health care: has a broader meaning. Essential health care based on practical, scientifically sound, and and acceptable methods of technology made universally accessible to individuals and families in the community through their full participation and at a cost that the community and country can afford to maintain at every stage of their development

-

-

A comprehensive care that includes disease prevention, community development, a wide spectrum of services and programs, working in interprofessional teams, and intersectoral collaboration for healthy public policy Primary health care is especially relevant to CHN for the following reasons: - Provides essential health services in the community - It considers the determinants of health - It focuses on health promotion, disease prevention, and protection - It includes therapeutic, curative and rehabilitative care - It promotes coordination and interprofessional collaboration - It focuses on the client as an equal partner in health with health care providers

 Principles of Primary Health Care: - Accessibility: the essential health services should be equitably distributed to all populations to provide access to health services for all - Health Promotion: emphasizes services that are preventive and promotive rather than curative, such as health education and immunization - Public Participation: individuals and communities should be involved in the planning and design of health services that affect their health - Intersectoral Collaboration: emphasizes the integration of health development with social and economic development - Appropriate Technology: concerned with the appropriate use of health care resources  Principles of Public Health Practice: Levels of Intervention and Prevention  - When working with clients, CHN need to determine whether upstream, midstream or downstream interventions are required - CHNs must not only focus on the individual, but also look further upstream for forces that may influence the individual’s health - Upstream thinking: looks beyond the individual to take a macroscopic, big-picture population focus. It also includes a primary prevention perspective and is a population health approach. At this level, “how can we change the causes of the causes, or the conditions that set up the conditions for the illness or injury?” - consider the determinants of health and other relevant economic, sociopolitical, and environmental factors that may influence health - Midstream thinking: addresses the micro-policy level: regional, local, community or organizational. At this level “how can we change the causes of illness or injury”? - Downstream thinking: taking an individual curative focus a view that does not consider economic, socio-political, and environmental facts. At this level, “how can the illness and the consequences be treated?”  Primordial Prevention: Includes broader activities that focus on preventing the emergence of risk factors that are known to create the conditions for disease. Involves actions to inhibit social, economic and environmental factors that are known health hazards  Primary Prevention: activities seek to prevent the occurrence of a disease or an injury. Examples include administering individual and mass immunizations, organizing community

vaccination programs for influenza, educate the community about the importance of hand washing  Secondary Prevention: activities seek to detect a disease early in its progression. Examples include conducting health screening programs to assess vision and hearing, or to detect breast cancer  Tertiary Prevention: activities begin once a disease has become obvious; goals are to interrupt the course of the disease, reduce the amount of disability that might occur, and begin rehabilitation. Examples include cardiac rehabilitation at a local wellness centre for groups of clients recently discharged following a cardiac event  Collaborative in Interprofessional Teams: - CHNs cannot be expected to be experts in all areas - Interprofessional collaboration and partnership development are essential in community health nursing practice - Collaboration among members of the interprofessional team contributes to ensuring that the client receives the best care possible (pg. 16)  Community Health Nursing Practice: - CHN practice includes identifying high-risk groups in the community - Once such groups are identified, the CHN can work with others to develop appropriate policies and interventions to reduce the risk and to provide beneficial services  Community Health Nursing Standards of Practice: - Standards define the scope and depth of practice by establishing criteria for acceptable nursing practice. They represent the desirable and achievable levels of performance expected of nurses in their practice and provide criteria for measuring actual performance  Standards of Practice: 1. Health Promotion 2. Prevention and Health Protection 3. Health Maintenance, Restoration and Palliation 4. Professional Relationships 5. Capacity Building 6. Access and Equity 7. Professional Responsibility and Accountability   Summary: Community health nursing is a specialty practice within the discipline of nursing. The primary focus of community health nursing practice is the health care of clients in the community. Public health nursing is community health nursing with a distinct focus on the health care of communities and populations. In community health nursing, the emphasis is on health promotion, health protection, and disease prevention. 

This chapter introduces concepts of community health nursing, such as client, community, Determinants of Health, primary health care, public health practice, population-focused practice, and upstream thinking. The Canada  Health Act and guiding organizations in Canadian public health care are introduced, as are the Canadian Community Health Nursing Standards of Practice. The social Determinants of Health are highlighted, and primary health care is discussed, with emphasis on social justice and global health.  CHAPTER 3: COMMUNITY HEALTH NURSING IN CANADA - SETTINGS, FUNCTIONS & ROLES  -

-

Community health nursing requires knowledge or primary health care and population health; health promotion and levels of prevention; determinants of health; equity and social justice; epidemiology; and evidence-informed practice CHNs must also have in-depth knowledge of the community they work in to function effectively

 General Community Health Nursing Functions and Practices: - What does the community believe about its health, needs, and strengths? - What determinants of health are relevant to the community? - What are the sociopolitical, cultural and ecological contexts? - Are there any ethical issues that need to be considered and addressed? - What determinants of health may be relevant to population health? - What possible population health issues exist for the community? - What health promotion issues need to be addressed in this community and for populations, aggregates, families and individuals?  Care and Counselling: - Must establish a therapeutic relationship with individuals, families, groups, communities, and populations - based on trust, respect, caring, and listening - Incorporate the nursing process, injury prevention techniques that are client centered, client driven, culturally safe, and strengths based - Help the community appreciate the assets and resources available, draw on their strengths, and take charge of their health and well-being - May provide direct care (complex wound management, infectious disease) - May have a more instructive role (teaching the client, family member, or community the practices they can manage in the community) - Self management: the work a person must undertake to live well with one or more chronic conditions  Risk Assessment and Response: - CHNs support the early identification of a disease or health threat by gathering data from many sources at the same time - Risk Communication: a strategic health education intervention that involves exchanging information on the potential harm of health or environmental hazards to risk assessors and managers, the general public, news media, and interest groups - Is a means of mitigating risk or preventing harm - I.e. educating family members of schoolchildren about vaccine safety through information provided in the consent forms for children to receive a vaccine at school

 Outreach: - CHNs use community assessment data to determine population health needs and design activities to address the unique features of the population of interest - Outreach practices serve to meet some of the unique access challenges faced by clients - CHNs design and implement strategies to engage with people where they live, work, learn, worship, or play to make care and counselling a community experience rather than something housed in a clinic set apart from the realities of clients’ lives - Build trusting relationships with clients and engage them in identifying and resolving health issues from clients’ unique locations - Outreach practices employs a holistic approach that includes finding creative solutions to client engagement and service-access barriers  Referral: - Referral process: the systematic process of directing a client to another source of assistance when the client or CHN is unable to address the client’s issue - The choice of referral process depends on the client’s needs, the availability and sustainability of local assets, and the capacity of the referring organization and the service to which the client is being directed at the same time - Must assess community strengths and assets  Discharge Planning: - The CHN often works with a community case manager to facilitate the transition of the client into the community - The client and family all need to be included in the discharge process as partners - A process that connects clients and services to ensure continuity of care after hospital and into the community - Requires interprofessional collaboration - Aims to maximize the quality of care so that the transfer of clients from hospital to community is smooth and capitalizes on the available health care resources  Health Education: - Involves strategic practices to inform people about health promotion, illness, prevention and treatment; it is a common function and practice of CHNs in any number of roles and settings - May provide health education to a client, family member, community or population, depending on the issue and selected intervention (pg. 59) - Must understand both the community health issues and the educational principles of teaching and learning to be able to design, implement, and evaluate health education activities at any level of intervention  Health and Health Literacy Assessment: - Individuals are limited in their ability to read, write, and communicate clearly - Health literacy: the ability to access, comprehend, evaluate and communicate information as a way to promote, maintain and improve health in a variety of settings across the life-course - Important to clarify what the client understands 

Community Development: - Recognize the value of community wisdom and support community-generated plans for economic development, environmental improvement - Encourage the community to be active in stating and taking ownership of health issues that need to be resolved  Research and Evaluation: - Engage in research and evaluation activities to investigate issues in and approaches to community health and wellness - By evaluating client and program outcomes, CHNs are able to question the status quo, support change in practice, and co-create relevant and effective action for community health  Screening and Surveillance: - Participate in evidence-informed community health nursing practice through ongoing health screening and data gathering and monitoring practices (e.g. screening for certain infections) - The CHN ensures the client understands why screening is necessary, how the procedure is done, and that follow-up is available  Health Advocacy: - Helps individuals, families and groups become aware of issues that may affect their health - Works to develop clients’ capacity to speak for themselves - A combination of individual and social actions designed to gain political and community support of the conditions which promote health  Case Management: is a collaborative strategy undertaken by health professionals and clients to maximize the client’s ability and autonomy through advocacy, communication, education, identification of and access to requisite resources, services and coordination - 5 Key Components: - Coordinating care - Ensuring continuity of care - Identifying changes in the patient’s condition - Evaluating the care being delivered in association with health care team members - Being aware of and understanding the financial implications of the care plan - Ensure clients understand why screening is necessary, how the procedure is done, that follow-up is available - Case manager: advocates for the client, advises the client, coordinates and facilitates access to suitable health care services in a timely manner, and ensures continuity of care for the client  Home Health Nurse: - Home care offers clients the benefits of familiarity and being surrounded by family, friends and pets - Function as generalists - are very knowledgeable in different fields

-

Family caregiving: support by family members in the home to meet the client’s basic needs such as personal hygiene, meal preparation, medications

 Occupational Health Nurse: - Focuses on workplace health and safety - Specifically the delivery of integrated health and safety services and wellness programs to individual employees and employee groups  CHAPTER 4: HEALTH PROMOTION  Enabling: taking action with clients to empower them to gain control over their health and environment with the goal of improving their health  Promotion of Health: - Use the nursing process to assess, plan, intervene and evaluate their practice from a micro level (i.e. the individual and family) to a macro level (i.e. systems and society) - Community health nursing process: the process by which CHNs make their community health nursing decisions  Development of the Concept of Health: - In the 1900s, health was defined as the absence of disease - Led to the view of health and illness as 2 opposing ends on a continuum and with health being measured by indicators of disease (morbidity and mortality statistics) - Focused primarily on disease in individuals, rather than families, groups, communities, populations or systems - In 1947, WHO amended the definition of health from “the absence of disease” to “health as a state of complete physical, mental and social well-being, and not merely the absence of disease” - Led to the view of health as a balance between physical, mental and social well-being, which led to a holistic approach to health - Other definitions followed to i...