ch 8 8th edition community gfhp

Chapter 8Chapter 8

Health Promotion and the CommunityHealth Promotion and the Community

Copyright © 2014 by Mosby, an imprint of Elsevier Inc.

CommunityCommunity

A specific group of people A specific group of people Often live in a defined geographical areaOften live in a defined geographical area Share a common culture, values, and norms Share a common culture, values, and norms Are arranged in a social structure, according to Are arranged in a social structure, according to

relationshipsrelationships Variety of settings, including workplaces, Variety of settings, including workplaces,

schoolsschools

Copyright © 2014 by Mosby, an imprint of Elsevier Inc. 2

The Nursing Process and the The Nursing Process and the CommunityCommunity

Community health nursingCommunity health nursing Combines nursing practice and public health to Combines nursing practice and public health to

promote health of populationspromote health of populations Develops relationships to accomplish community’s Develops relationships to accomplish community’s

health-related missionshealth-related missions Nurse’s roleNurse’s role

Interaction of independent, interdependent, Interaction of independent, interdependent, dependent functionsdependent functions

Community health promotionCommunity health promotion Community participation, community assessment, Community participation, community assessment,

targeted/measurable objectives, relevant targeted/measurable objectives, relevant interventions, evaluationinterventions, evaluation


The Nurses RoleThe Nurses Role

Community health nursing combines nursing practice Community health nursing combines nursing practice and public health concepts to promote the health of and public health concepts to promote the health of populations without limitation to any particular populations without limitation to any particular individual or group of individuals.individual or group of individuals.

Nurses supply educational information to at risk-Nurses supply educational information to at risk-communities to develop health-oriented skills, communities to develop health-oriented skills, attitudes, and related behavioral changes.attitudes, and related behavioral changes.

Community nurses also develop essential Community nurses also develop essential relationships aimed at accomplishing community’s relationships aimed at accomplishing community’s health-related missions.health-related missions.


Methods of Data CollectionMethods of Data Collection Observation dataObservation data

Windshield survey—use of senses to determine Windshield survey—use of senses to determine community appearancecommunity appearance

Interview data—verbal statementsInterview data—verbal statements Key community leadersKey community leaders Community residentsCommunity residents Health agency personnelHealth agency personnel

Measurement data—instruments to quantify data Measurement data—instruments to quantify data Population statistics, morbidity/mortality rates, U.S. Population statistics, morbidity/mortality rates, U.S.

census statistics, epidemiological and environmental census statistics, epidemiological and environmental datadata


Sources of Community Sources of Community InformationInformation

Census information located at Census information located at www.census.gov and also found in libraries and public agencies is and also found in libraries and public agencies is the most complete source for population the most complete source for population information. information.

Community agencies and local planning Community agencies and local planning commissions project statistics and commissions project statistics and developmental trends that nurses use to developmental trends that nurses use to understand population patterns and dynamics.understand population patterns and dynamics.

Many communities and states also have Many communities and states also have databases available for public use.databases available for public use.


http://www.census.gov/

Community fromCommunity froma Systems Perspectivea Systems Perspective

Systems theory—interrelated, interacting parts that filter Systems theory—interrelated, interacting parts that filter input/outputinput/output

Community structureCommunity structure Comprised of systems/subsystems (e.g., health care system)Comprised of systems/subsystems (e.g., health care system) Part of suprasystem (e.g., state)Part of suprasystem (e.g., state) Demography—study of populationDemography—study of population

• Provides direction for health strategiesProvides direction for health strategies Community function—process of dynamic Community function—process of dynamic

change/adaptationchange/adaptation Decision making and resource allocation importantDecision making and resource allocation important

Interaction—facilitates decision making, adaptationInteraction—facilitates decision making, adaptation


Community fromCommunity froma Developmental Perspectivea Developmental Perspective

Developmental theoryDevelopmental theory Focuses on particular age groups within the Focuses on particular age groups within the

communitycommunity Used to plan health promotion for groupsUsed to plan health promotion for groups Community age-related risk-factor examples:Community age-related risk-factor examples:

• Adolescent single mothersAdolescent single mothers

• Childhood accidentsChildhood accidents


Community fromCommunity froma Risk-Factor Perspectivea Risk-Factor Perspective

Risk-factor theory—risks affect community Risk-factor theory—risks affect community health/illnesshealth/illness Population risk factorsPopulation risk factors

• Demographic, psychological, physiological, environmentalDemographic, psychological, physiological, environmental Degree of influenceDegree of influence

• Differs from person to person and group to groupDiffers from person to person and group to group Increased risk with multiple factorsIncreased risk with multiple factors Goal is to control risk factors, make relevant health-Goal is to control risk factors, make relevant health-

related resources availablerelated resources available


Community AssessmentCommunity AssessmentThrough the Use of Functional Through the Use of Functional

Health PatternsHealth Patterns

Assessment of the communityAssessment of the community Graphic representation, mappingGraphic representation, mapping

Community diagnosesCommunity diagnoses Functional, actually dysfunctional, potentially Functional, actually dysfunctional, potentially

dysfunctionaldysfunctional Community patternsCommunity patterns


Functional Health Patterns: Functional Health Patterns: Assessment of the CommunityAssessment of the Community

Health Perception–Health Management PatternHealth Perception–Health Management Pattern Nutritional-Metabolic PatternNutritional-Metabolic Pattern Elimination PatternElimination Pattern Activity-Exercise PatternActivity-Exercise Pattern Sleep-Rest PatternSleep-Rest Pattern Cognitive-Perceptual PatternCognitive-Perceptual Pattern Self-Perception–Self-Concept PatternSelf-Perception–Self-Concept Pattern Role-Relationships PatternRole-Relationships Pattern Sexuality-Reproductive PatternSexuality-Reproductive Pattern Coping–Stress Tolerance PatternCoping–Stress Tolerance Pattern Values-Beliefs PatternValues-Beliefs Pattern


Health Perception–Health Health Perception–Health Management PatternManagement Pattern

Data aboutData about Community health statusCommunity health status Health promotion and disease prevention practicesHealth promotion and disease prevention practices Community member’s perceptions of health (e.g., Community member’s perceptions of health (e.g.,

substance abuse, unwanted pregnancies, STDs)substance abuse, unwanted pregnancies, STDs) Data sourcesData sources

Key community member interviewsKey community member interviews Mortality and morbidity statisticsMortality and morbidity statistics Other public health informationOther public health information


Nutritional-Metabolic PatternNutritional-Metabolic Pattern

Community consumption habitsCommunity consumption habits Accessibility/availability of food stores/subsidized Accessibility/availability of food stores/subsidized

food programsfood programs Well-being indicatorsWell-being indicators

• Adequate food intakeAdequate food intake• Presence/absence of kitchen facilitiesPresence/absence of kitchen facilities• Adequate plumbingAdequate plumbing

Data sourcesData sources Driving/walking through communityDriving/walking through community Government programsGovernment programs Private soup kitchensPrivate soup kitchens Food donations at houses of worshipFood donations at houses of worship


Elimination PatternElimination Pattern

Environmental factors including exposure to Environmental factors including exposure to pollutantspollutants PhysicalPhysical

• Geological, geographical, climatic, meteorological (e.g., air Geological, geographical, climatic, meteorological (e.g., air quality, humidity, inaccessible health care)quality, humidity, inaccessible health care)

BiologicBiologic• Living things hazardous to health (e.g., bacteria, viruses)Living things hazardous to health (e.g., bacteria, viruses)

Data sourcesData sources Observation; interviews with key informantsObservation; interviews with key informants Environmental Protection Agency; Centers for Environmental Protection Agency; Centers for

Disease Control and PreventionDisease Control and Prevention


Activity-Exercise PatternActivity-Exercise Pattern

Physical activities/recreational options Physical activities/recreational options within communitieswithin communities

Physical activity/musculoskeletal fitness Physical activity/musculoskeletal fitness important to healthy, independent living with important to healthy, independent living with agingaging

Data sourcesData sources ObservationObservation InterviewsInterviews


Sleep-Rest PatternSleep-Rest Pattern

Community’s rhythm of sleeping, resting, Community’s rhythm of sleeping, resting, relaxingrelaxing

Threats to sleep-rest patternThreats to sleep-rest pattern Ongoing activity from open businessesOngoing activity from open businesses Highway/airplane noiseHighway/airplane noise

Data sourcesData sources ObservationsObservations Interviews Interviews


Cognitive-Perceptual PatternCognitive-Perceptual Pattern

Problem solving and decision making within Problem solving and decision making within communitiescommunities

Provides clues about health priorities/values; Provides clues about health priorities/values; matches/mismatches between circumstances, matches/mismatches between circumstances, health goals, and planning strategieshealth goals, and planning strategies

Assessment includes appraising interaction with Assessment includes appraising interaction with environment; effectiveness of strategies to meet environment; effectiveness of strategies to meet health concernshealth concerns

Data sourcesData sources ObservationsObservations Interviews Interviews


Self-Perception–Self-Concept PatternSelf-Perception–Self-Concept Pattern

Community self-worth and self-identityCommunity self-worth and self-identity IndicatorsIndicators

Housing conditions, buildings, cleanlinessHousing conditions, buildings, cleanliness School systems, crime rates, accidentsSchool systems, crime rates, accidents Degree of competence with social/political issuesDegree of competence with social/political issues Amount community spiritAmount community spirit

Data sourcesData sources ObservationObservation InterviewsInterviews


Roles-Relationships PatternRoles-Relationships Pattern

Communication styles along formal/informal Communication styles along formal/informal relationships affecting community ability to reach health relationships affecting community ability to reach health potential potential Patterns of crimePatterns of crime Racial incidentsRacial incidents Social networksSocial networks

Official communication—publicizes health promotionOfficial communication—publicizes health promotion Health program success—needs support from Health program success—needs support from

prominent community membersprominent community members Data sourcesData sources

InterviewsInterviews Media sourcesMedia sources


Sexuality-Reproductive PatternSexuality-Reproductive Pattern Reproductive data of communitiesReproductive data of communities Reflected in birth statistics, mother’s age, Reflected in birth statistics, mother’s age,

ethnicity, marital statusethnicity, marital status Clues to health-promotion needs of specific groupsClues to health-promotion needs of specific groups Identifies high-risk groupsIdentifies high-risk groups Health concerns: Mismatch between services and Health concerns: Mismatch between services and

statisticsstatistics Data sourcesData sources

Meeting minutesMeeting minutes Health recordsHealth records Statistical dataStatistical data Public documentsPublic documents


Coping-Stress Tolerance PatternCoping-Stress Tolerance Pattern

Community ability to cope or adaptCommunity ability to cope or adapt Data sourcesData sources

Meeting minutesMeeting minutes Public documentsPublic documents Health surveys and recordsHealth surveys and records Statistical dataStatistical data


Values-Belief PatternValues-Belief Pattern

Family values, beliefs, and goalsFamily values, beliefs, and goals Selected assessment parametersSelected assessment parameters

Identification of family values/beliefsIdentification of family values/beliefs Flexibility of rulesFlexibility of rules Family view of spirituality; role of religionFamily view of spirituality; role of religion Cultural or ethnic practices; effect on illness/healthCultural or ethnic practices; effect on illness/health Family traditions/practicesFamily traditions/practices Value conflicts within familyValue conflicts within family Effect of values on healthEffect of values on health


Analysis and Diagnosis with the Analysis and Diagnosis with the CommunityCommunity

Analysis and diagnosis Analysis and diagnosis Data organization—charts, figures, tables, mapping Data organization—charts, figures, tables, mapping

(show change over time)(show change over time) Missing data—should be identified, look for Missing data—should be identified, look for

incongruent/conflicting information, validate dataincongruent/conflicting information, validate data Identifying community patternsIdentifying community patterns

Patterns from subjective and objective dataPatterns from subjective and objective data Formulate hypothesesFormulate hypotheses Identify at-risk community groupsIdentify at-risk community groups Establish probable causes/relationshipsEstablish probable causes/relationships


Analysis and Diagnosis with the Analysis and Diagnosis with the Community (Cont.)Community (Cont.)

Apply theories, models, norms, standardsApply theories, models, norms, standards Broad knowledge neededBroad knowledge needed Databases/guidelines provide information to identify health Databases/guidelines provide information to identify health

concerns/risksconcerns/risks Identify strengths/health concernsIdentify strengths/health concerns

Judgment and inferences about community health based on data Judgment and inferences about community health based on data interpretation interpretation

Range of determinations regarding status of problem and Range of determinations regarding status of problem and strategies indicatedstrategies indicated

Identify causes/risk factorsIdentify causes/risk factors Potential for alteration, elimination, or regulation through nursing Potential for alteration, elimination, or regulation through nursing

actionsactions Community diagnosesCommunity diagnoses

Form basis for planning, implementing, and evaluating solutionsForm basis for planning, implementing, and evaluating solutions


Planning with the CommunityPlanning with the Community

Planning/planned change with the communityPlanning/planned change with the community Prioritize problems, differentiate roles, identify goals Prioritize problems, differentiate roles, identify goals

and objectives, formalize plansand objectives, formalize plans Community nursing interventions—nurse-implemented Community nursing interventions—nurse-implemented

behavior to achieve community health goalsbehavior to achieve community health goals• Consider health belief models Consider health belief models • Communicate plans with other professionalsCommunicate plans with other professionals• Take steps to overcome resistance to changeTake steps to overcome resistance to change

Evaluation with the communityEvaluation with the community Actions: Lead to desired outcomes?Actions: Lead to desired outcomes? Directed at achievement of goalsDirected at achievement of goals Results in continued cycle of nursing processResults in continued cycle of nursing process


ch 8 8th edition community gfhp

Documents

imprint of elsevier

community nurses

public health concepts

community agencies

healthoriented skills

community assessment

public agencies

public use