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MZC 1 © 2005 by Lippincott Williams & Wilkins Unit IV: Community As Client Chapters 17 – 21

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Page 1: Comm Health Ppt

MZC 1© 2005 by Lippincott Williams & Wilkins

Unit IV: Community As Client

Chapters 17 – 21

Page 2: Comm Health Ppt

MZC 2© 2005 by Lippincott Williams & Wilkins

Introduction

In this unit we focus on the community as client. To be able to assess the community provides the foundation to understanding the community of caregiving. The first three chapters follow the nursing process and flow from the theoretical basis of community health nursing, assessment and diagnosis, and planning, implementing and evaluating. We then look at two chapters that explore two dramatic issues: communities in crisis and going beyond our borders to encompass the health and well-being of the global community.

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MZC 3© 2005 by Lippincott Williams & Wilkins

Chapter 17

Theoretical Basis of Community Health Nursing

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MZC 4© 2005 by Lippincott Williams & Wilkins

Objectives:

Upon mastery of this chapter, you should be able to:Discuss two essential characteristics of nursing service when a community is the client: community-oriented, population-focused care, and relationship-based care.Describe the contributions of at least five models of nursing practice to community health.Explain the benefits of applying eight tenets of public health nursing to community health nursing.Identify at least five social issues that influence contemporary community health nursing care.

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MZC 5© 2005 by Lippincott Williams & Wilkins

Essential Characteristics of Nursing Service to Populations

Community oriented, population focusedCommunity orientation is a process that is actively shaped by the unique experiences, knowledge, concerns, values, beliefs, and culture of a given community

Population focus implies that a nurse uses population-based skills such as epidemiology, research in community assessment, and community organizing as the basis for interventions

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MZC 6© 2005 by Lippincott Williams & Wilkins

Essential Characteristics of Nursing Service to Populations

Relationship based careEstablish and maintain a reciprocal, caring relationship with the community

Involves listening, participatory dialogue, and critical reflection

Involves sociopolitical elements of practice such as advocacy, community empowerment, and movement to action

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MZC 7© 2005 by Lippincott Williams & Wilkins

Theories of Community Nursing Practice

Nightingale’s Theory of Environment

Parse’s Human Becoming Theory

Milio’s Framework for Prevention

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MZC 8© 2005 by Lippincott Williams & Wilkins

Nightingale’s Theory of Environment

Focused on preventive care for populations

Nightingale used observations to validate her hypothesis

Poor environmental conditions are bad for health

Good environmental conditions reduce disease

Others have added social services and health care in addition to environment

Page 9: Comm Health Ppt

MZC 9© 2005 by Lippincott Williams & Wilkins

Parse’s Human Becoming TheoryOriginally “Man-living-health” theory

Three themes:1. Meaning

2. Rhythmicity

3. Transcendence

Page 10: Comm Health Ppt

MZC 10© 2005 by Lippincott Williams & Wilkins

Milio’s Framework for Prevention

Premise: Behavioral patterns of populations are a result of habitual patterns and limited choices

Challenged “lack of knowledge” concept

Proposed that government and institutional choices set the range of options for aggregate and individual choices

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MZC 11© 2005 by Lippincott Williams & Wilkins

Models of Community Nursing Practice

Orem’s Self-Care Model

Neuman’s Health Care Systems Model

Rogers’ Model of the Science of Unitary Man

Pender’s Health Promotion Model

Roy’s Adaptation Model

Salmon White’s Construct for Public Health Nursing

Minnesota Wheel – the Public Health Interventions Model

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MZC 12© 2005 by Lippincott Williams & Wilkins

Orem’s Self-Care Model

Communities can be considered to have a collective set of self-care actions and requirements that affect the well-being of the total groupSelf-care deficit: demand exceeds client abilities related to

Universal requirementsDevelopmental requirementsHealth deviation requirements

Nursing care supports client

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MZC 13© 2005 by Lippincott Williams & Wilkins

Neuman’s Health Care Systems Model: Figure 17-1

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MZC 14© 2005 by Lippincott Williams & Wilkins

Rogers’ Model of the Science of Unitary ManBased on systems theoryWhole is greater than the sum of the partsThree principles:

1. Life proceeds in one direction along a rhythmic spiral

2. Energy fields follow a certain wave pattern and organization

3. Human and environmental energy fields interact simultaneously and mutually, leading to completeness and unity

Page 15: Comm Health Ppt

MZC 15© 2005 by Lippincott Williams & Wilkins

Salmon White’s Construct for Public Health Nursing

Categories of nursing interventionsEducation directed toward voluntary change in the attitudes and behavior of the subjects

Engineering directed at managing risk-related variables

Enforcement directed at mandatory regulation to achieve better health

Interventions target determinants in four categories:

human/biologic, environmental, medical/technologic/organizational, and social

Page 16: Comm Health Ppt

MZC 16© 2005 by Lippincott Williams & Wilkins

Minnesota Wheel – the Public Health Interventions Model

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MZC 17© 2005 by Lippincott Williams & Wilkins

Application of Eight Tenets of PHN to CHN

1. Use a comprehensive and systematic process

2. Work in partnership with the people

3. Focus on primary prevention

4. Promote a healthful environment

5. Target all who might benefit

6. Give priority to community needs

7. Promote optimum allocation of resources

8. Collaborate with others in the community

Page 18: Comm Health Ppt

MZC 18© 2005 by Lippincott Williams & Wilkins

Social Issues Influencing CHN Care

Communication technology

Genetic engineering

Global economy

Migration

Terrorism and bioterrorism

Climate changes

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MZC 19© 2005 by Lippincott Williams & Wilkins

Case Study

Unit IV #1Using different nursing theories, apply each to the following community health situation: Incidences of asthma related symptoms have increased dramatically in the county in the past 10 years as indicated by higher numbers of emergency department visits, primary care provider visits, and school absences.

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MZC 20© 2005 by Lippincott Williams & Wilkins

Internet Resources

AACN’s Institutional Data Systems and Research Center (IDS): http://www.aacn.nche.edu/IDS/index.htm HealthWeb Nursing Page: http://www.healthweb.org/browse.cfm?subjectid=60 Interagency Council on Information Resources for Nursing (ICIRN): http://icirn.org National League for Nursing: http://www.nln.org Nursing Theory and Theorists: http://www.lib.flinders.edu.au/resources/sub/healthsci/A-Zlist/nursingtheory.html

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MZC 21© 2005 by Lippincott Williams & Wilkins

Clinical Activities

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MZC 22© 2005 by Lippincott Williams & Wilkins

Contact Information