1. Copyright © 2010, 2006, 2002 by Mosby, Inc., an affiliate of Elsevier Inc. Chapter 1 Community-Oriented Nursing and Community-Based Nursing Carolyn A. Williams

2. Copyright © 2010, 2006, 2002 by Mosby, Inc., an affiliate of Elsevier Inc. 2 Introduction  More nurses are engaging in community-based nursing (CBN), where the focus is on “illness care” of individuals and families across the life span  Growing cost of hospital care is leading to more care being provided in community-based settings  Community-oriented nursing has a broader focus than CBN and focuses both on the health care of entire communities or populations and the health care of individuals, families, and groups; this category includes the specialty of public health nursing  In community-oriented nursing the goal is to preserve, protect, promote, or maintain health

3. Copyright © 2010, 2006, 2002 by Mosby, Inc., an affiliate of Elsevier Inc. 3 What Is Public Health?  Public health  A scientific discipline that includes the study of epidemiology, statistics, and assessment – including attention to behavioral, cultural, and economic factors – as well as program planning and policy development  Public health is what members of a society do collectively to ensure that conditions exist in which people can be healthy

4. Copyright © 2010, 2006, 2002 by Mosby, Inc., an affiliate of Elsevier Inc. 4 What Are Benefits of Public Health?  Benefits of public health  Dramatic increase in life expectancy  Decreased number of deaths from stroke, coronary heart disease, and cancer  Declines in death rates of adults and children  Population-focused PH approaches could help prevent up to 70% of early deaths in America, compared with only 10% for medical treatment

5. Copyright © 2010, 2006, 2002 by Mosby, Inc., an affiliate of Elsevier Inc. 5 What Are Benefits of Public Health?  Benefits of public health (cont’d)  Public health practice provides many benefits, especially considering the small portion of the health care budget in the United States used for this prevention and population-focused specialty  Imagine how many more benefits the United States might see if more money was directed toward public health practice

6. Copyright © 2010, 2006, 2002 by Mosby, Inc., an affiliate of Elsevier Inc. 6 Public Health Core Functions  Assessment  Systematic data collection on the population, monitoring the population’s health status, and making information available about the health of the community  Policy development  Efforts to develop policies that support the health of the population, including using a scientific knowledge base to make policy decisions  Assurance  Making sure that essential community-oriented health services are available Includes providing essential personal health services for individuals, as well as a competent PH workforce Includes providing essential personal health services for individuals, as well as a competent PH workforce

7. Copyright © 2010, 2006, 2002 by Mosby, Inc., an affiliate of Elsevier Inc. 7 Levels of the Health Care Services Pyramid  Primary: both primary care and public health services that are designed to meet the basic needs of people in communities at an affordable cost  Secondary: services designed to detect and treat disease in the early acute stage  Tertiary: services designed to limit the progression of disease or disability  The base of the pyramid shows the effective services that will support the top tiers and contribute to better health  All tiers of the pyramid need to be adequately financed (U.S. Public Health Service, 1994, 2000)

8. Copyright © 2010, 2006, 2002 by Mosby, Inc., an affiliate of Elsevier Inc. 8 Essential Services of Public Health 1.Monitor health status to identify community health problems 2.Diagnose and investigate health problems and hazards in the community 3.Inform, educate, and empower people about health issues 4.Mobilize community partnerships to identify and solve health problems (cont’d on next slide)

9. Copyright © 2010, 2006, 2002 by Mosby, Inc., an affiliate of Elsevier Inc. 9 Essential Services of Public Health 5.Develop policies and plans that support individual and community health efforts 6.Enforce laws and regulations that protect health and ensure safety 7.Link people to needed personal health services and ensure the provision of health care that is otherwise unavailable (cont’d on next slide)

10. Copyright © 2010, 2006, 2002 by Mosby, Inc., an affiliate of Elsevier Inc. 10 Essential Services of Public Health 8.Ensure a competent public health and personal health care workforce 9.Evaluate effectiveness, accessibility, and quality of personal and population-based health services 10.Research for new insights and innovative solutions to health problems

11. Copyright © 2010, 2006, 2002 by Mosby, Inc., an affiliate of Elsevier Inc. 11 Population-Focused Nursing Practice  Population: A collection of individuals who share one or more personal or environmental characteristics  The term population may be used interchangeably with the term aggregate

12. Copyright © 2010, 2006, 2002 by Mosby, Inc., an affiliate of Elsevier Inc. 12 Population-Focused Nursing Practice  Subpopulations: Subsets of the population who share similar characteristics  For example, people older than 65 years who live in a residential home would be a subpopulation of a larger population of older persons in the community  Community: People and the relationships that emerge among them as they develop and use in common some agencies and institutions and share a physical environment

13. Copyright © 2010, 2006, 2002 by Mosby, Inc., an affiliate of Elsevier Inc. 13 Characterizing Public Health Nursing  Setting is frequently viewed as the feature that distinguishes public health nursing from other specialties; however, a more useful approach is to use characteristics such as the following:  A focus on populations who live in the community  An emphasis on prevention  Concern for the interface between health status of the population and the environment (physical, biological, sociocultural)  Use of political processes to influence public policy to achieve goals  The focus on populations in the community and the emphasis on health protection, health promotion, and disease prevention are the fundamental factors that distinguish public health nursing from other nursing specialties

14. Copyright © 2010, 2006, 2002 by Mosby, Inc., an affiliate of Elsevier Inc. 14 Characterizing Public Health Nursing  Public health nursing is a specialty with a distinct focus and scope of practice, and it requires a special knowledge base  Specialization in public health nursing is seen as a subset of community-oriented nursing practice  The primary focus that has differentiated public health nursing from other specialties has been the emphasis on the population rather than on single individuals or families

15. Copyright © 2010, 2006, 2002 by Mosby, Inc., an affiliate of Elsevier Inc. 15 Characterizing Public Health Nursing  The primary goal of public health (the prevention of disease and disability) is achieved by ensuring that conditions exist in which people can remain healthy  In public health nursing, the nurse often reaches out to those who might benefit from a service or intervention  In other forms of nursing, the client is more likely to seek out and request assistance

16. Copyright © 2010, 2006, 2002 by Mosby, Inc., an affiliate of Elsevier Inc. 16 Types of Practice Focus in Nursing  Individual, family, and group focused  Focus is on providing services to individuals rather than a population, while maintaining an appreciation for the values of the community  Example: Developmental screening tests of children in the Head Start preschool program to evaluate each child

17. Copyright © 2010, 2006, 2002 by Mosby, Inc., an affiliate of Elsevier Inc. 17 Types of Practice Focus in Nursing  Population focused   Emphasizes health protection, health promotion, and disease prevention of a population   Example: Look at children in the Head Start preschool program to evaluate if the program is achieving its goals

18. Copyright © 2010, 2006, 2002 by Mosby, Inc., an affiliate of Elsevier Inc. 18 Practice Focusing on Individuals, Families, and Groups  Community-oriented nursing  Primary focus is the health care of either the community or a population of individuals, families, and groups Broader in scope than community-based practice. A form of care in which the nurse provides health care after doing a community diagnosis to determine what conditions need to be altered in order for individuals, families, and groups in the community to stay healthy Broader in scope than community-based practice. A form of care in which the nurse provides health care after doing a community diagnosis to determine what conditions need to be altered in order for individuals, families, and groups in the community to stay healthy  Community-based nursing  The provision of acute care and care for chronic health problems to individuals and families in the community Occurs outside an institution; services are provided to individuals and families in a community Occurs outside an institution; services are provided to individuals and families in a community

19. Copyright © 2010, 2006, 2002 by Mosby, Inc., an affiliate of Elsevier Inc. 19 Four Key Nursing Modes in the Community  Community-oriented nursing practice  Public health nursing practice  Community-based nursing practice  Community health nursing practice

20. Copyright © 2010, 2006, 2002 by Mosby, Inc., an affiliate of Elsevier Inc. 20 Community-Based Nursing  Goal  Manage acute and chronic conditions  Focus is on “illness care” of individuals and families across the life span  Provide acute and chronic illness care and the provision of comprehensive, coordinated, and continuous care  A setting-specific practice – care is provided where people live, work, and attend school

21. Copyright © 2010, 2006, 2002 by Mosby, Inc., an affiliate of Elsevier Inc. 21 Community-Oriented Nursing  Goal  Prevent disease and disability; promote, protect, and maintain health  Focus is on “health care” of individuals, families, and groups in community  Provide health care to promote quality of life  Community diagnosis, health surveillance, monitoring and evaluation of community and population

22. Copyright © 2010, 2006, 2002 by Mosby, Inc., an affiliate of Elsevier Inc. 22 Community Health Nursing Practice  Goal  Preserve, protect, promote, or maintain health of individuals, families, and groups in a community  Practice focus  Health of individuals, families, and groups— and how their health status affects the community as a whole

23. Copyright © 2010, 2006, 2002 by Mosby, Inc., an affiliate of Elsevier Inc. 23 Public Health Nursing Practice  Goal  Prevent disease and disability and promote and protect the community as a whole  Practice focus  The community as a whole  The effect of the community’s health status (resources) on the health of individuals, families and groups

24. Copyright © 2010, 2006, 2002 by Mosby, Inc., an affiliate of Elsevier Inc. 24 Challenges for the Future  Current trend is to move more care into community settings and to reduce the number of hospital days for “sick” clients  Community care is less expensive  Community care is more appealing; people prefer to be at home rather than be treated in a hospital  This trend is expected to grow, and with it the role of the nurse in community settings will likewise grow and continue to change