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MZC 1© 2005 by Lippincott Williams & Wilkins
Unit IV: Community As Client
Chapters 17 – 21
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.
MZC 3© 2005 by Lippincott Williams & Wilkins
Chapter 17
Theoretical Basis of Community Health Nursing
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.
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
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
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
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
MZC 9© 2005 by Lippincott Williams & Wilkins
Parse’s Human Becoming TheoryOriginally “Man-living-health” theory
Three themes:1. Meaning
2. Rhythmicity
3. Transcendence
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
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
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
MZC 13© 2005 by Lippincott Williams & Wilkins
Neuman’s Health Care Systems Model: Figure 17-1
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
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
MZC 16© 2005 by Lippincott Williams & Wilkins
Minnesota Wheel – the Public Health Interventions Model
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
MZC 18© 2005 by Lippincott Williams & Wilkins
Social Issues Influencing CHN Care
Communication technology
Genetic engineering
Global economy
Migration
Terrorism and bioterrorism
Climate changes
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.
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
MZC 21© 2005 by Lippincott Williams & Wilkins
Clinical Activities
MZC 22© 2005 by Lippincott Williams & Wilkins
Contact Information