Chapter 7 Flashcards
for CHNs, theory may guide practice situations where rigorous ______________ __________ ________________ is not available
research based evidence
levels of theoretical knowledge include:
__________________
__________________
____________________
metaparadigm
philosophy
conceptual model (framework)
theories
what level of theoretical knowledge is this?
the global concepts essential to the practice of community health nursing
metaparadigm
what level of theoretical knowledge is this?
an abstract statement about what is believed to be true in terms of the development of knowledge and what is valued in terms of practice
philosophy
what level of theoretical knowledge is this?
a way to organize and visualize abstract statements about the relationships between knowledge and practice
conceptual model (framework)
what level of theoretical knowledge is this?
more concrete statements that can be derived from conceptual frameworks and from practice
theories
the CHNC model of the most important types of theoretical foundations to the discipline includes:
the CHN ________________
__________________ encompassing CHN ethics and values
broad _______________ perspectives (complexity science theory, social ecological theory, feminist theory, postcolonial theory)
conceptual _____________ and ______________ (various health promotion models, intervention wheel)
grand, middle range, and practice (or substantive) _______________
metaparadigm philosophies theoretical models frameworks theories
core concepts of CHN include: (7)
social justice population focus epidemiology health promotion/prevention equity determination of health cultural safety
_______________ provides roots that anchor both practice and research in the nursing discipline. ________________, in turn, produces evidence to guide the practice of the community health nurse in educational, administrative, policy making, and practitioner roles.
theory
research
A _______________ is an organized, coherent, and systematic articulation of a set of statements related to significant questions in a discipline and communicated as a meaningful whole”
theory
Nurses often have their own ideas about the cause of a particular issue or problem for a client, or about the best way to work with individuals, families, or communities to address that issue. These ideas are actually “_________________________” or “__________________________” about the problem and the solution
informal theories
theories in use
Key public health concepts that contribute to the practice of public health nursing include “social justice, a population focus, reliance on epidemiology, health promotion and prevention, the greater good [or common good], and long-term commitment to community”. Other concepts such as health equity, determinants of health, capacity building, a strengths-based approach, caring, cultural safety, and collaboration are important for community health nursing in Canada
social justice
Four fundamental patterns of knowing in nursing, including _______________ knowing, or the art of nursing that is actually feeling the experience with another; _________________ knowing, of oneself and the experiences that influence one’s perspectives; _______________ knowing, or a commitment of service with respect to human life and our moral obligations to society; and _______________ knowing, which is using scientific processes and rigorous methodologies.
aesthetic
personal
ethical
empirical
________________ knowing, which includes society’s knowledge of nursing, and nursing’s knowledge of society and its politics. This pattern of knowing called for nurses to find the “intersections between the health-related interests of the public and nursing and . . . become involved and active participants in these interests”. The _________________ environment is multi-layered, and influences on health include the social context of the person and family as well as the __________________ context of the larger community
sociopolitical
Health _______________ are health differences between population groups—defined in social, economic, demographic, or geographic terms—that are unfair and avoidable . Health ______________, on the other hand, means that all people are able to reach their full health potential and are not disadvantaged because of circumstances such as age, race, ethnicity, gender, or social class. It “involves the fair distribution of resources needed for health, fair access to the opportunities available, and fairness in the support offered to people when ill
inequities
equity
The level of ____________________ refers to the degree of complexity inherent in the knowledge component; the higher the level of ____________________, the less detail in the component. Starting with the most abstract, the types of knowledge are the community health nursing ___________________________, __________________,___________________________, and __________________
abstraction metaparadigm philosophies conceptual models and frameworks theories
give an example of a broad theoretical perspective
critical social theory
feminist theory
intersectionality
postcolonial theory
give an example of a conceptual model, framework or practice model
Calgary family assessment model
community health promotion model
health literacy model
health promotion model
transitional care model
give an example of nursing theory (grand nursing theories)
interpersonal relations
roys adaptation model
self care deficit model of nursing
theory of human becoming
transcultural/cultural care diversity and universality
waitrons human caring science
give an example of nursing theory (middle range nursing theories)
critical caring
give an example of nursing theory (practice or substantive nursing theories)
theory of collaborative decision making
theory of collaborative decision making is…
an example of a practice or substantive nursing theory
give an example of an other public health and social science theories, model, and frameworks
attachment theory
social cognitive theory/self efficacy theory
Public health nursing focuses on communities and populations from a health ________________ perspective.
promotion
there has actually been very little theory developed in, of, and for ___________________________ that takes into account the specific focus and concerns of community health nursing practice.
community health nursing
Community health nursing theory, practice, and research, is directed at multiple levels of practice, either separately or in concert. Practicing in diverse settings, including____________,_______________, ____________, organizations, community spaces, and the _____________, CHNs support the health and well-being of individuals, families, groups, communities, systems, and populations. Individual- level practice involves working with people to change knowledge, attitudes, practices, and behaviors. When working with individuals, CHNs consider families as both context and influence on individual-level health. They also consider families as the unit of care and use interventions that promote the health of the whole family. Families, of course, make up a healthy neighborhood and community.
homes
clinics
schools
street
_____________________-level practice looks to change community norms, attitudes, behaviors, and practices to promote the health of its members. Interventions are directed toward entire ________________, or to sub-populations “under threat”, and require partnership, intersectoral collaboration, and community engagement.
community
populations
_____________________-level practice is aimed at society-wide change and works to change laws, organizations, policies, or power structures in the community that influence health.
systems
__________________ is an important strategy for CHNs at the broader societal level. The Canadian Nurses Association (CNA) defines __________________ as “engaging others, exercising voice and mobilizing evidence to influence policy and practice.
advocacy
advocacy
A ______________________, the most abstract level of knowledge, identifies the phenomena of central concern to a discipline and describes the concepts and the relationships among them. There is general agreement that the central concepts in nursing include person or client, environment, health, and nursing. Although a nursing theorist may conceptualize each term somewhat differently, when these concepts are considered together they provide the broad parameters of nursing and help to articulate what the work is about
meta paradigm
The key aspects of nursing knowledge (metaparadigm) include? (5)
person health nursing environment social justice
because health inequities can only be addressed by consistently pursuing change at the system and population levels using political and economic solutions, ________________ must be the central concept and philosophy that guides community health nursing.
social justice
t or f
Social justice is explicitly named as a value of community health nursing
true
there is strong evidence that the conditions of our lives influence our health, and the term “_________________” refer to the social conditions that “interact to influence our health and well-being and affect how vulnerable we are to disease and injury”. The World Health Organization defined the _____________ as “the circumstances in which people are born, grow up, live, work and age, and the systems put in place to deal with illness”. These circumstances influence health at global and national levels but also at the local level
SDOH x 2
Nightingale identified a key strategy for promoting health, which is to make health issues visible to the ______________ and to _________________
public
politicians
An important philosophical value in community health nursing is to promote the ________________, which refers to the pursuit of shared human interests in survival, safety, and security for the good of all
common good
what theory is this?
the view that in any given situation there are numerous and diverse parts interacting with the potential to evolve to a new situation. there is no single complexity theory or approach to complexity. some of the core concepts include interconnectedness, non- linearity, self-organization, and co-evolution
complexity theory
what theory is this?
the health of individuals, communities, and populations is influenced by the interplay between people and their environment.
CHNs engage in health promotion activities and consider the array of factors affecting the health of the client and family
CHNs consider broad determinants of health, such as income, education, employment opportunities, physical environment, and support systems
social ecological theory
what theory is this?
considers the multiple social and economic forces resulting in power differentials within society.
Whether implementing strategies at the individual level or a broad population level, CHNs need to appreciate the multiple intersecting forces at play shaping the lives and well-being of those cared for. Places equity issues in the foreground. From this perspective a CHN challenges the status quo and engages with the problems of society
critical social theory
what theory is this?
Focuses on the role of sexism and oppression in creating inequities. it is a component part of intersectionality
feminist theory
what theory is this?
considers the multiple oppressive forces at play. has more of a focus on feminism as well as other “isms” such as racism and classism, and the compounding effect of the overlap among them.
intersectionality theory
what theory is this?
considers the role of race and history in creating inequities
Working with many different groups in the community, CHNs need to be aware of the influence and expectations of the dominant culture, what impact that could have on the local community, and their place within it. the focus is on oppression in causing health inequities
postcolonial theory
____________________________________ are the “scaffolding” for theories. Much of the development of theory in community health nursing has been in conceptual models and frameworks. A _________________________________ is defined as a set of relatively abstract and general concepts, the propositions that describe those concepts, and the general relations between the concepts.
conceptual models and frameworks
conceptual models and frameworks
what conceptual model or framework is this?
this conceptual model depicts the community as a dynamic system that interacts with its environment and moves iteratively through the phases of community assessment, analysis, diagnosis, planning, intervention, and evaluation. it sees interventions as primary, secondary, or tertiary preventive levels, and is consistent with the broad determinants of health.
Canadian community as partner
what conceptual model or framework is this?
this conceptual model guides CHNs to use collaborative community actions to improve sustainable health outcomes for the community. this is done by employing health promotion strategies at the community level. the nursing process and primary health care are integral to how this model is applied
community health promotion model
at conceptual model or framework is this?
this widely used Canadian model demonstrates the link between population health and health promotion at various levels of action. the model is used to identify specific actions as well as demonstrate how to combine various actions to create a comprehensive action strategy. attention is directed to individual, family, and community levels.
Population health promotion: an integrated model of population health and health promotion
what conceptual model or framework is this?
this American nursing conceptual model focuses on health-promoting behavior directed toward positive health outcomes at an individual level. it identifies how a range of individual experiences and characteristics affect the health-promoting behavior of individuals. it is particularly useful in changing personal health especially in home healthcare, but less so for changing social determinants as it does not address the broader population.
Health promotion model
what conceptual model or framework is this?
the Calgary family assessment model is an integrated, multi-dimensional frame-work based on systems, cybernetics, communication, and change theory. this is a model that can be used to assess a family or as an organizing framework for clinical work with individual families. it focuses on the interaction among all individuals within a family and is inclusive of past, present, and future family members.
Calgary family assessment model
what conceptual model or framework is this?
this American model outlines nursing care for the individual, family, and community. CHNs practicing in different settings will have different areas of practice and require different kinds of expertise. multi-level practice is described within a population-centered perspective. an integrated approach supports the broad scope of practice in the community and provides a basis for collaboration and partnership
an integrative model for community health nursing
what conceptual model or framework is this?
also known as the Minnesota intervention wheel, this model demonstrates the relationships between interventions and outcomes for different levels of practice. it depicts how PHNs improve population health through interventions with individuals, families, and communities, as well as the systems that impact on the health of communities. it considers the determinants of health and emphasizes health promotion and prevention interventions to improve population health.
intervention wheel
______________ theories are broad in their scope, and the concepts are described in abstract terms.
They can be used in a broad range of practice situations and provide high level guidance to practice and research
grand
what grand nursing theory is this?
this grand nursing theory focuses on the interaction between individuals and their environment. __________ identified four modes of adaptation to achieve health, including physiological, self-concept, role function, and interdependence. the purpose of this theory is to explain how nurses can facilitate the change process toward an individual’s intended goals.
roys adaption model
what grand nursing theory is this?
the self-care model aims to facilitate the client- nurse interaction to preserve the integrity of human beings through self-care by offering 10 self-care actions. the agency and capacity of the client are enhanced by strategies directed at controlling, maintaining, and motivating actions toward self-care. Orem explains the need for nursing as the inability to provide self-care due to situations of personal health.
self care deficit theory of nursing
what grand nursing theory is this?
three principles comprise this theory. the first is that people structure and knowingly choose the meaning of their reality. the second is that people create patterns in their life, which convey meaning and value. the third principle is that people continuously change in life as they engage with and choose from an infinite range of possibilities. Parse’s theory of human becoming fits well with the work of CHNs. the ebb and flow of relationships, altered by changing environmental or personal circumstances, make up the fabric of the work CHNs engage in. understanding and using Parse’s approach helps in moving toward desired outcomes from the client’s perspective, and guides nurses to practice in a wholly respectful way.
theory of human becoming
_____________________________ theories contain a limited number of variables or concepts, are fairly narrow in their scope ad have a lower level of abstraction than either grand theories or conceptual models. These characteristics increase their usability for theory based practice and research. ______________________ theories not only provide direction for practice, they are used to generate testable hypotheses for research
middle range
name some middle range theories
critical caring theory
strengths based theory
relational inquiry
what middle range theory is this?
Canadian nurse scholar Falk-rafael identifies seven carative health-promoting processes that reflect the core of public health nursing. this middle range theory uses a broad definition of client to encompass communities and populations. the carative health-promoting processes include the process of teaching and learning, the creation of supportive and sustainable environments, social justice, building capacity, and honoring local belief systems.
critical caring theory
what middle range theory is this?
this Canadian approach incorporates thinking about the positives, the things that work well, and what holds potential. it is about finding the balance between focusing on client strengths while at the same time dealing with problems. it is oriented to the individual, family, and community levels of intervention
strengths based theory
what middle range theory is this?
these Canadian nurse scholars explain how relational practice focuses on the way that personal, interpersonal, and contextual elements shape people’s experiences and life situations. this approach considers how capacities and socio- environmental limitations influence people’s health and illness experiences, decision making, and the various ways of managing health and illness. it recognizes that health, illness, and experiences are shaped by social, economic, cultural, family, historical, and geographical contexts as well as by biology, gender, age, and ability.
an example from practice is work that CHNs do with vulnerable families living in poverty, and the importance of developing a trusting and respectful relationship with individuals and families, as well as with the larger community.
relational inquiry
_______________ or ________________ theories are the least complex, contain fewer concepts, and refer to specific, well-defined phenomena. Practice theories tend to be prescriptive and thus provide direction for practice
practice
substantive
what practice/substantive theory is this?
this Canadian model of support in palliative nursing considers six dimensions of nursing care: valuing, maintaining integrity, connecting, empowering, doing for, and finding meaning. this model focuses on CHN practice at the individual and family levels
supportive care model
what practice/substantive theory is this?
this Canadian theory describes the process through which palliative patients live with hope and acknowledge life as it is. this theory discusses how health status can be assessed and mutual plans developed among nurse, client, and family in order to maximize the abilities of the individual and family within the context of the community.
theory of hope
Drawing on nursing’s metaparadigm, CHNs have developed a unique metaparadigm that defines the concepts in ways that reflect their phenomena of concern, explains the levels of practice, and places ____________________ at the core. CHNs’ work has been informed for many years by theoretical perspectives such as social ecological theory, feminism, and critical social theory and more recently by emerging perspectives such as complexity science, postcolonial theory, and intersectionality. CHNs have also developed a range of models and frameworks to guide research and practice that (a) draw from the core theoretical concepts of community health nursing, (b) reflect CHNs’ values base, (c) direct action at the multiple levels of intervention for CHNs, ranging from the individual to society, and (d) encompass the full range of community health nursing competencies across the continuum of care, including health promotion, disease prevention, health maintenance and restoration, and palliation.
social justice
Jason’s story demonstrates how the living conditions in which people are born, live, and play influence their_____________ and increase the chances of preventable ____________. These unfair and avoidable circumstances are commonly referred to as the _______________, where an imbalance of money, resources, opportunity, and power result in health inequities between people in society. Actions to address these conditions that ensure access to health (versus access to healthcare) take place at multiple levels, and CHNs work at all of these levels. CHNs do not work solely with individuals to help them address the problems they encounter after they occur, but they work ________________ to prevent them from occurring—not only for the individuals concerned but for the communities of which they are members. CHNs collaborate and work with families, communities, and populations as well as at the political level to build capacity for people to take action on improving their own health, advocating for the determinants of health in order to promote equity and _______________________
health injury SDOH upstream social justice
critical social theory
______________________ helps us identify systems of oppression, marginalization and shifts our gaze to the structural and systemic determinants of health. this approach shifts our gaze from the notion that the individual made an informed choice…to identifying the social and political structures that create systematic disadvantage
_______________ and _________________ theory help us to give voice to the subjugated….helps us to understand the multiple social identities that intersect and for some serve to construct social oppression and privilege
intersectionality
postcolonial
