Chapter 3 Thinking Upstream: Nursing Theories and Population-Focused Nursing Practice

Question 1

Whole purpose of community health is

Answer 1

upstream and preventing issues in the first place; upstream thinking - promote health and prevent issues in the first place - looking at the cause; want know how got to that place to begin with

Question 2

Health care today

Answer 2

Health and poor health is complex and multifaceted. Health issues within pops and communities today is multifaceted and very complex; think poor health as river then save someone as drowning but so busy saving victims from the river that do not look upstream who/what caused be in river in the first place; nurses in conflict communities need to know where to focus time, energy, and resources
Nurses need to look at the root cause of health problems if going to help the community; - nurses have to build strong community relationships to advocate for community members in scientifically responsible, logical, and persuasive way

Question 3

Thinking upstream: examining the root causes of poor health

Answer 3

Nurse deal with both; community targets and promotes more upstream thinking
Downstream:
Upstream Thinking

Question 4

Downstream: (Thinking upstream: examining the root causes of poor health)

Answer 4

Typ see in medical environment; hospital/ER; someone developed issue and you are dealing with it right then and there; treat disease/MI and do something to address it right them
Focus on Correcting the problem after it has occurred
Health care takes place in Emergency Departments, Critical Care Units, & other healthcare settings focused on illness care

Question 5

Upstream Thinking (Thinking upstream: examining the root causes of poor health)

Answer 5

More about preventation
Preventative measures; may be something you can do individually but may have to lobby someone higher up for education programs or get into politics and lobby for more money for prevention programs
Focuses on Preventing problems before they happen/occur
Actions focus on Modifying economic, political, and environmental factors that are the precursors to poor health throughout the world; poor health precursors: poor diet, smoking, phys inactivity, alcohol use
Goal is change variables that contribute to poor health
Current US healthcare sys emphasizes episodic and individualized care; chronic diseases responsible for 70% deaths anually and 86% healthcare costs
Nursing has history providing Preventative and population – based care - should focus on health promotion and maintenance from that perspective

Question 6

Microscopic approach to solving community health probs

Answer 6

Examines individual, and sometimes family, responses to health and illness
Often Emphasizes behavioral responses to individual’s illness or lifestyle patterns
Nursing interventions are often aimed at modifying an individual’s behavior through changing the person’s perceptions or belief system.
Indiv is the focus of change
Community health dealing with indivs and groups; dealing with indiv = microscopic view/issue; deal with specific behavior

Question 7

Macroscopic approach to solving community health problems

Answer 7

Focus on Examines interfamily and intercommunity themes in health and illness
Delineates factors in the population that perpetuate illness or foster the development of health
Emphasizes social, economic, and environmental precursors of illness
Nursing Interventions may include modifying social or environmental variables. - improving living conditions/sanitation; may also involve social/political action
Society is the focus of change - aligned with the upstream view
Community as whole/aggregate as whole
Emphasize more broad and gen solutions - not telling indivs but aggregates with same issue and why have something

Question 8

Review of theoretical approaches

Answer 8

Theories exemplify nursing approaches to solving healthcare problems
Individual is the focus of change (Microscopic); Downstream thinking - focus on one indiv
Society is the focus of change (Macroscopic); Thinking Upstream - looking at community as whole

Question 9

Individual is the focus of change (Microscopic); Downstream thinking - focus on one indiv (Review of theoretical approaches)

Answer 9

Orem’s self-care deficit theory of nursing

Health Belief Model

Question 10

Orem’s self-care deficit theory of nursing (Individual is the focus of change (Microscopic); Downstream thinking - focus on one indiv (Review of theoretical approaches)

Answer 10

Based on the assumption that self-care needs and activities are the primary focus of nursing prac
Looking at an indiv person, looking at logic and reason, what missing, how end up in this situation, what is the driving factor but still individualized and targeted

Question 11

Health Belief Model (Individual is the focus of change (Microscopic); Downstream thinking - focus on one indiv (Review of theoretical approaches)

Answer 11

Based on the assumption that the major determinant of preventative health behavior is disease and disease avoidance
How individual believes something that leads to their choices

Question 12

Society is the focus of change (Macroscopic); Thinking Upstream - looking at community as whole (Review of theoretical approaches)

Answer 12

Milio’s Framework for Prevention - focused on this

Critical Social Theoretical Perspective

Question 13

Milio’s Framework for Prevention - focused on this

Answer 13

Directs attention upstream and examines opportunities for nursing intervention at the pop level by understanding the community’s health needs and resources
Is group related
Does focus on the pop as a whole; not for an indiv; for a big pop

Question 14

Critical Social Theoretical Perspective

Answer 14

Uses societal awareness to expose inequities that keep people from reaching their full potential
Can address either/or

Question 15

Critical interactionism

Answer 15

Merges the microscopic and macroscopic theories to address issues of the upstream AND downstream levels to make healthcare sys changes - can use both approaches to address healthcare issues
Microscopic (Downstream) + Macroscopic (Thinking Upstream)

Question 16

Healthy People 2020 & 2030

Answer 16

Whole point is that it is a national organization and looking at root causes of probs; go to list to figure out what probs most prominent on website and gives entire list of issues that our national pop has that needs to be addressed
Consider root causes of health problems and create societal and physical environments that promote good health - thinking of root causes understand importance of directing nursing efforts toward the causes/anticedants of poor health and lost opportunities; social determinants of health topic area within healthy people 2020 & 2030 is designed to identify ways to create social and phys environments that promote health for all
In both social determinants assert that All Americans deserve equal opportunities to make choices that lead to good health
To ensure that all Americans have the opportunity to promote good health Advances are needed in healthcare, education, childcare, housing, business, law, media, community planning, transportation, and agriculture
Designed to think about root causes for healthcare probs