Chapter 13 Flashcards
community
________________: a group of people who live, learn, work, and play in an environment at a given time; often also defined by place (geopolitical boundaries), beliefs or interests (aggregate communities) or virtual communities
community
community functions
___________ _______________ are the necessities that sustain day to day livelihood
community functions
community dynamics
____________ _____________ support community functions through effective communication, leadership and decision making
healthy communities
_____________ ________________: a movement based on the concepts of health and health promotion and intersectoral partnerships working together to create a sustainable and healthy community
Intersectoral collaboration is the joint action taken by health and other government sectors, as well as representatives from private, voluntary and non-profit groups, to improve the health of populations. Intersectoral action takes different forms such as cooperative initiatives, alliances, coalitions or partnerships.
community as partner model
_________________________: main attributes are community (based on the community assessment wheel depicting components such as physical environment, education, safety and transportation and nursing process, etc) and nursing process (based on stress adaptation model)
_________________ framework: CHNs use the _____________ triangle (host-environment-agent) to examine the frequency and distribution of a ___________ or _________________
epidemiology
epidemiology
disease
health condition
community capacity
_______________: the capacity building process strengthens the ability of a community, or health organization to develop and implement health promotion initiatives; capacity building is realized when the community is empowered to change and to overcome deficits to achieve strong infrastructure to support its functions
community health promotion model (CHPM)
the ______________________ emphasizes that the health of the population is influenced by the interplay of various social determinants of health in the environments they live in an uses this understanding to guide community planning, intervention and evaluation
the process of community health nursing is continuous and cyclical; it consists of 4 phases, name them
assessment
planning
implementation
evaluation
community assessment
___________ ________________ is an ongoing quantitative and qualitative appraisal of the community
the intervention plan must address the challenges to achieving health for all: reducing ____________, increasing ____________ and enhancing community __________________
inequalities
prevention
coping
nursing interventions will be successful when the community is fully _______________ and _______________ throughout the nursing process
engaged
empowered
_________________ and ________________ community data help form the needed indicators for evaluation of any evidence of success
subjective
objective
community _______________ approach is key to community planning and empowers people to take responsibility and ownership in health and to effect change
participatory
community needs matrix tool
allows participants to discuss, identify, rate, or explain which health problems are most important to communities and to chart this data; CHNs facilitate discussion to learn about community experience
community mapping
a schematic map of the distribution and occurrence of illness, disease, health; resources; environmental conditions; and accessibility and barriers to services
present-future drawings
allow CHNs to see where the community wants to go and formulate mutual intervention goals/objectives
population health promotion
an approach to health that aims to improve the health of the entire population and to reduce health inequities among population groups…it acts upon the broad range of factors and conditions that have a strong influence on our health
risk assessment
identify and target clients who are most likely to contract a particular disease or develop unhealthy behaviours, and assess attributes that affect their health
community governance
refers to decision making in health organizational matters that help to meet the health needs and priorities of the community; effective when it engages citizens, measures results, and gets things done
community engagement
is a participatory process based on communication, trust and a common understanding and purpose
capacity building
process to strengthen the ability of an individual, an organization, a community or a health system to develop and implement health promotion initiatives and sustain positive health outcomes over time
CHNs work with communities as they define goals, mobilize resources, and develop action plans; might include support for political action to change environments or strengthening resources for healthy living
community development
taking action at a grassroots level to generate solutions to common problems that will eventually involve the larger community
community mobilization
CHNs must be competent in using the community health promotion process in which they implement their ________________ health care roles to address health ______________ for the ________________ populations
primary
inequities
marginalized
CHNs will demonstrate _______________ in community health promotion and advocate for the importance of ______________-focused health promotion
leadership
population
CHNs use various community participatory ____________ to engage community stakeholders and population groups to address community health needs, to advocate positive change
tools
Community health nurses (CHNs) care for people where they live, learn, play, and work. Their goal is to improve the health of the ______________ by promoting, preserving, and protecting the health of individuals, families, aggregates, and populations. Their practice includes promoting health, building individual or community capacity, connecting and caring, facilitating access and equity, and demonstrating professional responsibility and accountability
community
CHNs must determine who and where their clients are, and why, what, when, and how best to promote their health in the ______________.
community
Not only do CHNs need to attend to the post- hospital complex care for their clients, they must respond to the diversity and changing population demographics of their populations, who are aging rapidly with the rising rates of ___________ illnesses. Additionally, CHNs must strive to work autonomously to build community partnerships that are based on a philosophy of ___________ health care to achieve health for all.
chronic
primary
CHNs have always cared for the community as their clients. Historically, CHNs cared for sick and ___________ individuals and families
Today, CHNs continue to care for their clients in various community settings, healthy or sick, from homes to ____________, workplaces, community centers, and clinics
CHNs also work with the community as ____________; they collaborate with multidisciplinary teams of healthcare providers, politicians, leaders, and the public at large to implement an affordable, accessible, and well-integrated primary health care system to meet the needs of their community
destitute
schools
partner
CHNs help strengthen the various social determinants of health and advocate for _____________ in health
equity
A ________________ may be defined as a group of people who live, learn, work, and play in an environment at a given time. They share common characteristics and interests, and function within a larger social system such as an organization, region, province, or nation. The core of any community is its _____________, who are characterized by their age, sex, socioeconomic status, education level, occupation, ethnicity, and religion.
community
people
A community is also defined by its place or ___________________ boundaries, which often are used to determine the location of service delivery
geopolitical
_________________ boundaries refer to both geographic boundaries such as mountains, rivers, or lakes, and political boundaries such as districts or areas of service delivery that are bounded by legal jurisdictions with real or imagined boundaries.
geopolitical
aggregate communities
virtual communities
________________ communities refer to groups of people with common interests, culture, beliefs, or goals. ________________ communities such as chat rooms, MySpace, blogs, Twitter, WhatsApp, and Facebook, are places where members share their common interests on the Internet.
aggregate
virtual
All communities provide the following community functions:
-space and infrastructure for housing,______________, recreation, government, and health and social services
- _______________ and income, including productivity and distribution through consumption of goods, trading, and economic growth
- security, protection, and law enforcement to protect the public from ____________
- participation,________________, and networking for all community members
- linkages with other community systems for opportunities for ______________ and capacity building.
schools employment crime socialization growth
Community functions are supported by three interactive community dynamics: effective ________________________, ______________, and decision making
communication
leadership
_________________ Competent communities have strong and cohesive vertical, horizontal, and diagonal patterns of communication among the community key partners.
_______________ communication links communities to larger communities or to those with higher decision-making power.________________ communication connects the community to work collaboratively with its own members, environment, and other service systems. _________________ communication reinforces the cohesiveness and communication of all system components, both horizontally and vertically, and helps reduce the silo effects that occur when communication is done only vertically and horizontally.
communication
vertical
horizontal
diagonal
Leadership Leaders lead their members by influencing the decision-making process using their status and _______________ in the community. ________________ leaders are elected official politicians, such as mayors, members of parliament, or the prime minister. _______________ leaders are those with prominent positions in the community, such as religious leaders, executives or representatives of community organizations or professionals, elders of community groups, philanthropists, celebrities, or local heroes.
position
formal
informal
Decision Making __________________ leaders use government policies to make decisions for the community, while ________________ leaders use their status to influence community groups and to effect change. Effective leaders collaborate with community groups to advocate for optimal change.
formal
informal
_______________________ was a movement that began in the 1980s and became an international movement that promotes the health and well-being of members in the community. The guiding principles of __________________________ are based on the concepts of health and health promotion, and that community members from multiple sectors working together to create a sustainable and healthy community.
healthy communities
healthy communities
A \_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_ process involves: o Equitable community engagement o Intersecctoral partnerships o Political commitment o Healthy public policy o Asset based community development
healthy communities
Qualities of a healthy community include:
o Clean and safe _______________ environment
o Peace, equity, and ___________________
o Adequate access to ____________, water, shelter, income, safety, work and recreation for all
o Adequate access to ________________ services
o Opportunities for learning and skill development
o Strong, mutually supportive relationships and networks
o_________________ that are supportive of individual and family well being
o Wide participation of residents in decision making
o Strong local _______________ and spiritual heritage
o Diverse and vital economy
o Protection of the natural environment
o Responsible use of resources to ensure long term _______________________
physical social justice food healthcare workplaces cultural sustainability
frameworks
CHNs use models and ____________________ to systematically collect data and analyze the relationships of various data components.
Most existing nursing models and frameworks focus only on _______________ and not community care
individual
epidemiologic triangle (___________-_____________-__________) to examine the frequency and distribution of a disease or health condition in the population being studied. They determine what the community is, who is affected (____________), where and when the condition occurred (_________________), and why and how (______________) it occurred.
host
environment
agent
host
environment
agent `
____________ _____________ is a process to strengthen the ability of an individual, an organization, a community, or a health system to develop and implement health promotion initiatives and sustain positive health outcomes over time. It involves human resource and skills development, leadership, partnership, resource allocation, and policy formulation. Optimal _______________ ________________ is realized when the community is empowered to change and to overcome deficits to achieve a strong infrastructure to support its functions and dynamics
capacity building
capacity building
community asset ______________ is used to outline the assets and capacity of the community and identify strengths and potential resources for program planning and interventions
CHNs evaluate the “_____________” and build community capacity through activities such as strategic planning, community mobilization, and community development
mapping
assets
The goal of the community health promotion model (CHPM) is to??
apply community health promotion strategies to achieve collaborative community actions and to improve sustainable health outcomes of the community
The CHPM (community health promotion model) incorporates strategies from ____________ health promotion framework, the ____________________________, and ______________ health care principles to guide community planning, intervention, and evaluation. Nursing ______________ and __________________ health care are an integral part of the CHPM.
epps
ottawa charter of health promotion
primary
process
primary
The CHPM (community health promotion model) provides a framework for purposeful and systematic community ______________, _______________, _______________, and _______________. It uses a holistic approach to promoting the health of the population to attain a higher quality of community life and health equity. The CHPM emphasizes the health of the population is influenced by the interplay of various ___________________ in the environments they live in. These may include employment, housing, food, education, childhood years, workplace safety, social inclusion, and access to health systems.
assessment planning implementation evaluation SDOH
The process of community health nursing is continuous and cyclical; it consists of four phases: ________________, _______________, ________________, and ______________________.
This goal-oriented activity enables CHNs to collect relevant community data, critically analyze the problem or issue, make inferences on the implications of the problems or issues, formulate community nursing diagnoses, plan and implement the interventions, and evaluate the outcomes.
assessment
planning
implementation
evaluation
community _________________ is an ongoing systematic appraisal of the community. It is a comprehensive process because the health of the community clients is affected by the complexity of community functions and dynamics and the various _________________________. Some key questions that guide the beginning steps of community assessment are as follows:
- what is the purpose of my community assessment?
- Why is it needed?
- Which SDOH are being affected?
- What would be the best approaches or techniques to collect my community data?
- Who, how, and when should I engage the community to do these?
assessment
SDOH
There are four types of community assessment that may be used alone or in a combination: name them
environmental scan
needs assessment
problem investigation
resource evaluation
__________________: The most preliminary assessment of the community is this, in which one scans the overall environment through a ________________ survey. CHNs use their senses of sight, touch, hearing, and smell to gather information and form their preliminary assessment of their community.
By scanning the ________________, CHNs can familiarize themselves with their work environment and connect people to the resources in the environment in which they live. Windshield surveys are best done at ________ different times of day and on different days of the week for data comparison purposes.
environmental scan
windshield
environment
two
_________________: Appropriate and cost-effective services that meet the health needs of the population are based on the community’s needs or deficits, not on its unrealistic wants or desires. needs are what the community experiences as the gap between its current situation and desired situation. To perform a ______________________—for example, opening a teen health Centre—CHNs must (a) investigate the nature of the needs, (b) determine if the expressed needs represent the opinions of the community, and (c) determine whether the community is willing and has the resources to take action for change.
needs assessment
needs assessment
_____________________: these are conducted in response to a problem or concern
problem investigation
_____________________: this involves the assessment and evaluation of existing community resources and services. This includes an examination of the adequacy of human, financial, and physical resources, community partnerships, service utilization, gaps and duplications, affordability, and accessibility to the target populations.
resource evaluation
n short, community assessment begins with a PISO statement, what does that stand for?
population
intervention
setting
outcome
Community _____________ and _________________: Understanding the past allows the CHN to build on existing strengths and avoid repeating the same failures. Areas for examination include the history of the issues of concern and community actions taken in the past; the attitudes of officials and local politicians; and the community’s perceptions, attitudes, beliefs, and felt needs for health, education, and healthcare services.
history
perception
_____________: a diverse group of people or aggregates residing within the boundaries of a community
population
A ____________ refers to two or more people, while an _____________________ is a group of people with common interests, demographics, cultural heritages, and socioeconomic and education levels. Population and aggregates are terms commonly used interchangeably
group
aggregate
A ________________ population refers to the population for whom nursing intervention is intended
target
Population at _____________ refers to a group of individuals who have a high probability of developing illness
risk
People who are disadvantaged, susceptible, or vulnerable to health inequity, injury, disease, or premature death are described as a _____________ or _________________ population
priority
vulnerable
In addition to biology and genetic endowment, CHNs also examine the composition of the population by age distribution, sex, marital status, social class, occupation, birth rate, employment, religion, education level, family size, and other factors related to their developmental and situational needs. Community data such as trends in ________________ rates (e.g., maternal and infant death rates and suicide rates), _______________ rates (e.g., common infectious diseases and chronic conditions), and life ________________ give indications regarding the health status of the population. CHNs study the rate of population growth or decline to examine the population trends and plan for anticipated services. People tend to reside in areas for a variety of reasons: proximity to their employment and extended family, accessibility to education, amenities, recreational facilities, crime rate, political reasons, and climate. The density of the population may shift with time and demographic makeup. Communities are not _____________. The needs, characteristics, makeup, and health status of the population also change over time within its physical and social environments. promoting healthy lifestyles and community support to combat social isolation and poverty is much needed in the remote northern communities because of their higher rates of smoking, obesity, suicide, and alcohol use compared to the nation’s averages
mortality
morbidity
expectancy
static
_________________: The_______________ of the community refers to where the target population lives, works, plays, and learns. Healthy communities do not exist in isolation; they have permeable ________________ for the exchange of services among communities
boundaries
boundary
boundaries
_______________ boundaries include geographic boundaries, such as mountains, valleys, roads, lakes, rivers, or oceans. _________________ boundaries include (a) political boundaries, which depict governance of various townships, counties, cities, and provinces; and (b) situational boundaries, which are governed by specific circumstances such as zoning for school children, traffic patterns, or smoking areas.
physical
artificial
___________________: Physical, chemical, biological, social, and psychosocial factors in the environment contribute to our quality of life. ______________ environments include (1) biological and chemical characteristics: vegetation and forestry, animals and insects, bacteria and other microorganisms, food and water supply, chemicals, and toxic substances; and (2) physical characteristics: geography, climate, and natural resources such as soil, mountains, valleys, rivers, lakes, oceans, water, air, oil, and designs of communities, buildings, and roads.
environments
physical
________________ environments: The interaction between social and economic conditions of the community affects the health and well-being of individuals and populations. High employment rates, new housing, and business developments are common signs for communities with a healthy economy. In poor economic times, a community must have resources such as social services, housing, and food banks to assist those in need.
socioeconomic
Employment and working conditions: Unemployment, under- employment, economic instability, and stressful or unsafe working conditions significantly affect not only people’s physical, mental, and social health and general well-being, but their _____________ and _________________. People who are employed and work in a safe workplace experience less stress, live longer, and have fewer health problems
families
communities
Diversity and social inclusion: Healthy communities embrace harmony, safety, and _______________ as the social norm. For example, schools instill cultural awareness and sensitivity in young children, thereby reducing racism or bullying. Social inclusion by gender, age, ability, sexual orientation, race, ethnicity, and religion will create a community where people feel they belong and so strive to reach their full potential as members
diversity
________________: provides a form of socialization and a means for healthy physical and mental activity for people out- side of their family, school, and work life
recreation
Education and healthy child development: ________________ provides people the needed life skills and technical skills for their day- to-day living and, therefore, health and prosperity. Canadians with low literacy skills are more likely to be poor and unemployed, suffer from poor health, have low self-esteem, and miss opportunities for learning and community participation than those with higher levels of education. Poor early childhood developmental characteristics, such as low birth weight or poor ________________, can delay language or brain development and compromise physical and mental health through to adulthood. Disadvantaged and low-income children tend to not perform well in school; they are at greater risk for poor health. CHNs can advocate for adequate social policy surrounding issues such as parental _____________, national childcare pol- icy, unemployment benefits, and social assistance to meet the health and social needs of families and children
education
nutrition
leaves
Culture and religion: One in every five Canadians is foreign- born and belongs to a visible minority group. _____________ offers a form of spiritual support for many people, especially those in crisis; it can also frame individuals’ healthcare practices. _______________ is the way we think, live, act, believe, and feel. Various ethnocultural groups in many Canadian communities strive to preserve their heritage through their own social activities and language classes. Visible minorities and new Canadians with language and cultural barriers are often alienated from the mainstream society and experience inequities in _________________ from poverty, social isolation, bullying, and poor access to services (e.g., high unemployment or underemployment rates in newcomers and a high incidence of suicide and diabetes in Aboriginal people). Consequently, many ethnic groups tend to live and work in their own ethnic communities to avoid __________________. CHNs must address the diversity, cultural competence and safety and societal tolerance as they work with this population.
religion
culture
health
marginalization
Health and social services: Health services include primary, secondary, and tertiary care, ranging from promotion and protection of health to ______________, rehabilitative, and ______________ care services. Social services, including welfare, unemployment benefits, mothers’ allowance, and disability pensions, are examples of assistance for those who are single parents, unemployed, or have physical or mental dis- abilities. An infrastructure of a wide range of health and social services can help people emerge from their crises. Territorialism and unwillingness to share information or resources among community agencies for fear of losing program funding often result in fragmentation or duplication of services. CHNs assess what and how health and social services are used and delivered to their communities, and whether service gaps, unmet needs, duplications, and strengths exist. They work with the community to facilitate better coordination and more accessible and affordable _____________ to the people in need.
hospital
palliative
services
Transportation: A reliable and affordable transportation system is necessary to ensure that community members have access to the essential _____________ they need. CHNs attend to the transportation needs for rural clients, the poor, the frail elderly, and those with physical limitations; and they mobilize resources to meet their needs
services
Government and politics: Governments set policies to deliver essential services to meet the basic needs and goals of the community. They provide formal leadership to communities and reinforce compliance to their policies (e.g., smoke-free regulations, service agreements). While _____________ leaders hold authority in making decisions, __________________ leaders and community members often have the power to influence change. CHNs must be aware of the existing government policies, work with both formal and informal leaders, and be involved in the decision-making process. They assess the relationships and the degree of cooperation or conflict between the community and other agencies or decision-making bodies.
formal
informal
Law and safety: Governments set rules and regulations as law. Crimes such as homicides, assaults, and thefts are symptoms of family and community response to ____________ (e.g., family violence, unemployment, and drug use). _______________ is a prerequisite to quality of life. CHNs assess whether residents are feeling safe by examining the occurrences of crimes (i.e., types, rates, and locations) and collaborating with the police in crime prevention to create a safe place for people to live.
stress
safety
It is essential for CHNs to be very clear on the purpose of their community ______________ and to use credible and appropriate sources and techniques to collect valid community ___________.
Generally, existing data should be examined before gathering _____________ data. New data can be gathered from surveys and meetings with community residents and leaders or other key informants
assessment
data
new
There are two main types of community data: (1) ___________________ data, such as facts and figures shown in population statistics or health status reports, and (2) __________________ data, such as statements or opinions gathered from windshield surveys, focus groups, forums, key informants, or public or town hall meetings
quantitative
qualitative
what are some common community data sources: (5)
participant observation
literature review
demographic and epidemiologic data
national and local policy data
community surveys
community surveys
___________________: are a series of questions addressing the issue(s) or population(s) being studied. They capture a broad range of data from a representative sample population in a short period of time. They can be conducted via regular mail, Internet, telephone, or face-to-face interviews. The data collected provide a snapshot of the population being studied at that particular time and may be generalized to describe the larger population. National surveys are usually done every 5 to 10 years to examine changes in behaviors over time.
community forums
_______________________: are public meetings in which community members discuss issues of concern and share their experiences and opinions with their community leaders or decision makers. they are an inexpensive way to collect community data. The people who attend these meetings are either directly involved in or affected by the topic being discussed (e.g., the impact of a school closure, service restructuring in a community, or crime reduction in a neighborhood). CHNs should note that when opinions are expressed by one person or a few people who dominate the discussions, their opinions may not represent the majority’s view and the purpose of the forum may be derailed. they should be conducted by trained facilitators to elicit maximum public response.
focus groups
__________________: are small group discussions with an average of 8 to 12 people that usually last one to two hours. focus groups are smaller in scale and the participants are more homogeneous in their characteristics or experience related to the issue or topic being discussed. these and community forums are useful for collecting more in-depth information, such as qualitative data when surveys fail to serve this purpose. They are not a place for debate or confrontation. use multiple strategies to collect the needed data as no single source or method can provide all the assessment data on a community. Epidemiological and research skills are particularly important for analyzing and interpreting vital statistics and figure
Population health builds on the traditional practice of health promotion and public health with a focus on ______________ activities and _____________ management
preventive
disease
________________ health is “an approach to health that aims to improve the health of the entire population and to reduce health inequities among population groups. . . . it acts upon the broad range of factors and conditions that have a strong influence on our health”. Federal, provincial, territorial, and local governments play a leadership role to implement population health policies and set clear program goals and targets.
population
__________________ populations contribute to the overall productivity and quality of life in the community, and to a sustainable and equitable healthcare system. Based on this belief, the Public Health Agency of Canada developed a population health template with eight key elements and corresponding action steps for health practitioners, educators, and researchers: (1) focus on the health of population, (2) address the determinants of health and their interactions, (3) base decisions on evidence, (4) increase upstream investments, (5) apply multiple strategies, (6) collaborate across sectors and levels, (7) employ mechanisms for public involvement, and (8) demonstrate accountability for health outcomes. There are also international health indicators that measure quantifiable information on the health of the population and the healthcare system: (1) health status, (2) non-medical determinants of health, (3) health system performance, (4) community and health system characteristics, and (5) equity
healthy
Promoting the health of the populations in their com- munity is not new to CHNs. To excel in this, CHNs must overcome ______________ and ________________ barriers that impede their care. Community organizations need to provide an infrastructure that supports population health promotion. CHNs also need to develop competent knowledge and skills on community health nursing, with an emphasis on leadership, community partnership, policy development, and advocacy skill
personal
systemic
Risk assessment: CHNs assess the conditions of risks and benefits that apply to the entire population or to its significant aggregates, and deliver health services only to those who are at ____________. risk refers to the probability or likelihood that healthy persons exposed to a specific factor will acquire a specific disease. These specific factors, called risk factors, can be ________________,_______________, and_________________ factors (e.g., sources of exposure, cultural practices, patterns of behavior, local concerns, direct impact from the service delivery system), or ___________________ factors (e.g., age, sex, or genetic makeup). When doing risk assessment, CHNs identify and target clients who are most likely to contract a particular disease or develop unhealthy behaviors, and assess attributes that affect or potentially affect their health
risk environmental lifestyle psychosocial biological
the purpose of ____________ __________ is to identify actual and potential community strengths and needs that are relevant to the improvement of existing health services. Competent community analysis relies on a clear conceptual understanding of how social determinants interact and have an impact on health and on community functions and dynamics. Community data are systematically summarized into categories and compared with other relative community systems for significance; inferences are then made to formulate community nursing diagnoses.
data analysis
Formulation of community nursing diagnoses must be based on community assessment ____________ collected. community nursing diagnoses may be problem or wellness diagnoses, with statements consisting of the following components:
o Specific aggregate or target group
o Actual or potential unhealthy or healthy response/situation that a nurse can change
o Etiology or cause for the unhealthy or healthy response/situation
o Characteristics or evidence that describe the response or situation
data
Planning implementation or evaluation: Once the identified community needs are prioritized, the CHN devises ____________________ to resolve those needs. The intervention plan should address the challenges to achieving health for all: reducing inequalities, increasing prevention, and enhancing
community coping. The goals and objectives for intervention are derived from the community nursing __________________.
interventions
diagnoses
Nursing interventions include primary, secondary, and tertiary preventive services that reflect the five principles of primary health care: _______________, ____________ _______________, _______________ _____________, appropriate ___________________, and public __________________. Population-focused health promotion strategies include but are not limited to advocacy for healthy public policy, the strengthening of community action, and the creation of supportive environments
accessibility health promotion intersectional cooperation technology participation
CHNs, such as home health or community-based nurses, focus on direct- care services to individuals and families, whereas public health nurses (PHNs) provide _______________- focused care. Specific public health nursing interventions include consultation, counseling, health teaching, case management, referral and follow-up, screening, outreach, disease surveillance, policy development and enforcement, social marketing, advocacy, community organizing, coalition building, and collaboration
population
Nursing interventions will be successful when the community is fully ______________ and _______________ throughout the nursing process.
engaged
empowered
_______________ and ______________ community data help form the needed indicators for evaluation of any evidence of success. Community planning and interventions will be effective when public policy and supportive environments are addressed and when the community is committed to work on the identified need or issue
subjective
objective
A _________________ participatory approach is key to community planning. Through dialogue with stakeholders and community members during the process, the community decides what makes a need become a priority, who is to take the action, what the action will be, and when and how it is to be done. Community participatory tools help quantify and qualify the health issues, needs, or concerns that they identify. Active participation and sharing of experiences can empower people to take responsibility and ownership in health and to effect change
community
__________________________ Participants may use the community tool to discuss, identify, rate, or explain what they perceive to be the most important health problems or the most feasible interventions in their community. The degree of concern about each issue is tallied on a blank chart, which shows this community is most concerned about accidents.
Community Needs Matrix Tool
community ________________ is a schematic map of the community indicating the distribution and occurrence of illness, disease, and health; major resources; environmental conditions; and accessibility and barriers to various services. Community members may examine their accessibility and the resources in their environment, and CHNs use the members’ expressed perceptions and experiences to mutually formulate the intervention plans.
mapping
CHNs may ask their community clients to draw a ____________________ drawing to reflect upon their present situation and what resources and constraints contributed to it, and to visualize how the future might appear. This tool allows the nurse and the clients to see where the community wants to go and, hence, to formulate mutual intervention goals and objectives.
present-future
Community ________________ and community engagement are pivotal to achieving program sustainability and accountability, building community capacity, and social equity. community ________________ refers to management, leadership, and decision making in health organizational matters, which are usually undertaken by a group of community stakeholders, to meet the health needs and priorities of the community through community engagement and empowerment. Effective community _______________ must encompass three community skills: engaging citizens, measuring results, and getting things done
governance
governance
governance
community ___________________ is the “process of involving a community in the identification and strengthening those aspects of daily life, culture life, and political life which sup- port health. This might include support for political action to change total environment and strengthen resources for healthy living”. Community _____________ begins with a need or a vision for change. The process to bring on the change usually starts with one or a few individuals at a grassroots level, taking collective action to generate solutions to common problems, and it eventually involves the larger community. The process is referred to as community mobilization. Community ________________ involves capacity building and community mobilization
development x 3
Community development focuses on consensus building, improving, strengthening, and sustaining community life and local conditions to enable people, particularly those in disadvantaged situations, and to engage them in decision making to achieve greater _____________ over their circumstances
control
Community interventions must be evaluated to measure the ________________, whether the expected results were achieved or not. The steps for community program evaluation are (1) determining what needs to be evaluated based on the evaluation criteria; (2) engaging stakeholders throughout the process; (3) determining the appropriate methods of measurement; (4) developing data collection instruments, budget, and timeline for evaluation; (5) collecting and analyzing data; (6) reporting and disseminating the results; and (7) making decisions for action.
outcomes
CHNs work in complex social, political, and economic environments as they care for the diverse population. They have the professional and social responsibility to build a healthy community by providing accessible and quality care to meet the needs of _______________, ______________, _________________, ________________, and their ______________. CHNs must be competent in using the community health promotion process in which they implement their primary health care roles to address health inequities for the __________________ populations. They engage the community and strategically invest primary, secondary, and tertiary levels of prevention to strengthen individual and community capacity, to identify populations who are at risk, and to provide maintenance, protective care, and palliative care for their clients as needed. Expert CHNs will demonstrate competent leadership in community health promotion and advocate for the importance of population- focused health promotion. They will use various community participatory tools to engage community stakeholders and population groups to address community health needs, to advocate positive change, and to strive to achieve the ____________ for all.
individuals families aggregates populations community
marginalized
health
When practicing in community settings, CHNs must ask themselves,
“What does caring for a _____________ mean?” “Where and how do I begin?” and “What is a _____________ community?”
community
healthy
Community as a Client Vs. Community as a Partner
• As a Client:
- Caring for clients in community settings including homes, schools, centers and clinics
- Think Nightingale working to improve sanitation to reduce infections and deaths when caring for soldiers
• As a Partner
-Collaboration between multiple healthcare providers, politicians, leaders, and public at large to strengthen social determinants of health
♣ 2 attributes
• Community attribute - community assessment wheel, depicts components:
physical environment, education, safety and transportation, politics and government, health and social services, communication, economy, and recreation
• Nursing Process attribute: based on stress adaptation mode
• Lines of resistance (strengths) to protect community from harm
• Normal lines of defense describe the normal state of health in the community
• Flexible lines of defense: outermost layer to buffer community from stressors which can penetrate defenses to impact equilibrium
…
Defining ________________:
-A group of people who live, learn, work, and play in an environment
-Can also be defined by its place and geopolitical boundary
community
Communication:
-_______________ - links communities to larger communities of larger decision making powers
- ________________ - connects community to work collaboratively on its own
- ______________- both vertical and horizontal, reinforces cohesiveness and communication
vertical
horizontal
diagonal
• Leadership:
_____________- elected officials/politicians
______________ - prominent positions (religious leaders, elders of groups..)
formal
informal
Formal leaders use_____________ to make decisions
policy
Community Health Promotion Model:
- Incorporates: Epp’s health promotion framework and Ottawa charter of health promotion
- Guides community planning, _______________ and evaluation
- An adaptation of the nursing process in a population health promotion perspective
- Emphasizes health influenced by ______________
intervention
SDOHs
__________________ Aims to improve the health of the entire population and reduce health inequities among population groups
population health
Population Health Indicators include?
- Health __________
- Non-___________ determinants of health
- Health system performance
- Community _______________
- Health system characteristics
- _____________
status
medical
characteristics
equity
• Population Health Promotion Components
- Risk _______________ - refers to the probability for healthy persons exposed to a specific factor will acquire a specific disease
- CHNs identify clients most likely to contract disease or develop unhealthy behaviours
-______________ and Nursing Diagnoses
-Actual and potential community strengths and needs relevant to health services
-Analysis includes understanding of SDOH interplay
-Diagnoses must consist of:
Specific target group
Actual or potential response/situation that can be acted upon
Cause of unhealth response/situation
Characteristics describing response/situation
-________________, Implementation, and _________________
______________ should use a participatory approach in which dialogue between community members decide which needs become priority and actions
-Interventions should work to resolve needs and challenges, and include: primary, secondary, and tertiary preventative services
• Follows five principles of primary health care: accessibility, health promotion, intersectoral collaboration, appropriate technology, and creation of supportive environment
•\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_ should include: Determining what needs to evaluated Engaging stakeholders through process Determining methods of measurement Developing data collection methods and resources Timeline for evaluation Collecting and analyzing data Reporting and disseminating data Decisions for further action
assessment analysis planning evaluation planning evaluation
_____________ refers to the process to bring about change starting with one individual/group to eventually involve the larger community
mobilization
